| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,807 |
1,782 |
$51K |
| D1120 |
Prophylaxis - child |
1,233 |
1,219 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,193 |
1,894 |
$35K |
| D0145 |
Oral evaluation for a patient under three years of age |
245 |
243 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,082 |
2,048 |
$30K |
| D1351 |
Sealant - per tooth |
1,065 |
213 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,049 |
2,007 |
$24K |
| D0272 |
Bitewings - two radiographic images |
879 |
865 |
$20K |
| D1110 |
Prophylaxis - adult |
134 |
129 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
14 |
$3K |
| D0274 |
Bitewings - four radiographic images |
77 |
75 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$105.16 |
| D0602 |
|
1,387 |
1,375 |
$0.00 |
| D0601 |
|
189 |
186 |
$0.00 |
| D0603 |
|
223 |
221 |
$0.00 |