| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,263 |
1,225 |
$33K |
| D1110 |
Prophylaxis - adult |
466 |
457 |
$23K |
| D0274 |
Bitewings - four radiographic images |
560 |
539 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,240 |
1,219 |
$17K |
| D1120 |
Prophylaxis - child |
495 |
483 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,225 |
1,180 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,190 |
1,090 |
$12K |
| D1351 |
Sealant - per tooth |
420 |
73 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
16 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
44 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
46 |
$1K |
| D0272 |
Bitewings - two radiographic images |
52 |
48 |
$1K |
| D0601 |
|
1,351 |
1,334 |
$0.01 |
| D0603 |
|
112 |
109 |
$0.00 |