| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
818 |
808 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
290 |
106 |
$22K |
| D1120 |
Prophylaxis - child |
520 |
515 |
$19K |
| D0274 |
Bitewings - four radiographic images |
440 |
436 |
$15K |
| D1110 |
Prophylaxis - adult |
252 |
249 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
891 |
883 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
861 |
853 |
$11K |
| D1351 |
Sealant - per tooth |
378 |
79 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
876 |
849 |
$10K |
| D0272 |
Bitewings - two radiographic images |
260 |
258 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
25 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$459.16 |
| D0602 |
|
813 |
805 |
$0.00 |
| D0601 |
|
59 |
59 |
$0.00 |