| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,252 |
2,210 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
572 |
287 |
$56K |
| D1120 |
Prophylaxis - child |
1,403 |
1,383 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,427 |
2,585 |
$47K |
| D1110 |
Prophylaxis - adult |
764 |
751 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,530 |
2,488 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,711 |
2,664 |
$32K |
| D0274 |
Bitewings - four radiographic images |
859 |
841 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,090 |
1,079 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
175 |
92 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
57 |
57 |
$8K |
| D1351 |
Sealant - per tooth |
275 |
84 |
$7K |
| D0330 |
Panoramic radiographic image |
143 |
143 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
14 |
$494.48 |
| D0603 |
|
1,149 |
1,118 |
$0.00 |
| D0602 |
|
1,171 |
1,142 |
$0.00 |
| D0601 |
|
53 |
53 |
$0.00 |