| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
4,192 |
1,558 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,366 |
1,330 |
$37K |
| D1120 |
Prophylaxis - child |
908 |
885 |
$31K |
| D1351 |
Sealant - per tooth |
1,191 |
215 |
$29K |
| D1110 |
Prophylaxis - adult |
551 |
538 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,584 |
1,547 |
$22K |
| D0274 |
Bitewings - four radiographic images |
722 |
702 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
241 |
96 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,682 |
1,634 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
69 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$519.29 |
| D1330 |
|
26 |
26 |
$36.75 |
| D1999 |
|
536 |
504 |
$0.00 |
| D0601 |
|
1,222 |
1,210 |
$0.00 |
| D0602 |
|
168 |
163 |
$0.00 |
| D0603 |
|
25 |
24 |
$0.00 |