| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,467 |
1,372 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,673 |
1,563 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
484 |
228 |
$32K |
| D1110 |
Prophylaxis - adult |
660 |
596 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,970 |
1,854 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
814 |
738 |
$8K |
| D0274 |
Bitewings - four radiographic images |
309 |
287 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
127 |
69 |
$7K |
| D1351 |
Sealant - per tooth |
308 |
45 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
246 |
218 |
$6K |
| D0272 |
Bitewings - two radiographic images |
280 |
266 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
588 |
528 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
61 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$2K |
| D1206 |
Topical application of fluoride varnish |
14 |
13 |
$189.63 |
| D0603 |
|
1,236 |
1,184 |
$0.00 |
| D0602 |
|
725 |
696 |
$0.00 |
| D0601 |
|
115 |
111 |
$0.00 |