| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,018 |
978 |
$28K |
| D1110 |
Prophylaxis - adult |
497 |
485 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
267 |
111 |
$25K |
| D1120 |
Prophylaxis - child |
665 |
650 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,488 |
1,451 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,357 |
1,299 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,306 |
1,193 |
$14K |
| D0274 |
Bitewings - four radiographic images |
344 |
330 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
119 |
66 |
$9K |
| D1351 |
Sealant - per tooth |
307 |
40 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
245 |
223 |
$7K |
| D0272 |
Bitewings - two radiographic images |
306 |
298 |
$7K |
| D0350 |
|
281 |
269 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
30 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$2K |
| D1330 |
|
13 |
13 |
$159.75 |
| D0603 |
|
807 |
795 |
$54.21 |
| D0602 |
|
359 |
358 |
$0.00 |
| D0601 |
|
205 |
202 |
$0.00 |