| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,054 |
2,896 |
$79K |
| D0274 |
Bitewings - four radiographic images |
1,837 |
1,746 |
$58K |
| D1110 |
Prophylaxis - adult |
1,163 |
1,106 |
$57K |
| D1120 |
Prophylaxis - child |
1,638 |
1,554 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
487 |
233 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,312 |
3,417 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,231 |
3,073 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,704 |
3,506 |
$42K |
| D1351 |
Sealant - per tooth |
1,038 |
213 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
332 |
170 |
$25K |
| D0272 |
Bitewings - two radiographic images |
615 |
590 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
65 |
65 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
88 |
84 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
15 |
$3K |
| D0603 |
|
3,264 |
3,152 |
$0.00 |
| D0602 |
|
194 |
181 |
$0.00 |