| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,169 |
1,141 |
$32K |
| D1120 |
Prophylaxis - child |
640 |
628 |
$22K |
| D1110 |
Prophylaxis - adult |
393 |
382 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,378 |
1,349 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,704 |
835 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
896 |
874 |
$11K |
| D0272 |
Bitewings - two radiographic images |
355 |
348 |
$8K |
| D0274 |
Bitewings - four radiographic images |
234 |
232 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
107 |
104 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
15 |
$3K |
| D1351 |
Sealant - per tooth |
65 |
19 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$423.84 |
| D0602 |
|
321 |
314 |
$0.00 |
| D0601 |
|
755 |
741 |
$0.00 |
| D0603 |
|
65 |
65 |
$0.00 |