| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
915 |
286 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92 |
44 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
298 |
280 |
$8K |
| D1120 |
Prophylaxis - child |
219 |
205 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
337 |
318 |
$4K |
| D1351 |
Sealant - per tooth |
185 |
39 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
330 |
310 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
81 |
77 |
$2K |
| D0603 |
|
469 |
449 |
$0.00 |