| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,974 |
2,919 |
$82K |
| D1120 |
Prophylaxis - child |
1,387 |
1,371 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,049 |
2,985 |
$43K |
| D1110 |
Prophylaxis - adult |
783 |
766 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,133 |
1,112 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,984 |
1,930 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,856 |
1,811 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
211 |
99 |
$20K |
| D0272 |
Bitewings - two radiographic images |
716 |
708 |
$16K |
| D1351 |
Sealant - per tooth |
514 |
102 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
60 |
55 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
24 |
$3K |
| D0602 |
|
1,004 |
985 |
$0.00 |
| D0603 |
|
1,839 |
1,803 |
$0.00 |