| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
5,874 |
2,044 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,985 |
1,807 |
$50K |
| D1110 |
Prophylaxis - adult |
974 |
872 |
$45K |
| D1120 |
Prophylaxis - child |
1,227 |
1,127 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
466 |
181 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,047 |
925 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,469 |
2,199 |
$26K |
| D1351 |
Sealant - per tooth |
829 |
133 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,223 |
1,056 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
992 |
960 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
97 |
94 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
135 |
53 |
$8K |
| D0272 |
Bitewings - two radiographic images |
400 |
348 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
239 |
196 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
24 |
$545.85 |
| D0601 |
|
1,827 |
1,670 |
$0.01 |
| D0431 |
|
23 |
12 |
$0.00 |
| D0603 |
|
252 |
220 |
$0.00 |
| D0602 |
|
186 |
184 |
$0.00 |