| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
2,751 |
997 |
$24K |
| D1120 |
Prophylaxis - child |
754 |
742 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
208 |
69 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
762 |
754 |
$18K |
| D1351 |
Sealant - per tooth |
836 |
131 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,476 |
1,440 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,110 |
1,095 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
92 |
92 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
267 |
261 |
$7K |
| D1110 |
Prophylaxis - adult |
117 |
116 |
$4K |
| D0272 |
Bitewings - two radiographic images |
188 |
185 |
$4K |
| D1206 |
Topical application of fluoride varnish |
230 |
226 |
$3K |
| D0330 |
Panoramic radiographic image |
80 |
80 |
$2K |
| D0603 |
|
2,029 |
1,998 |
$23.17 |