| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
466 |
449 |
$12K |
| D1120 |
Prophylaxis - child |
311 |
301 |
$10K |
| D1351 |
Sealant - per tooth |
410 |
80 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
503 |
482 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
559 |
537 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
552 |
512 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$5K |
| D0274 |
Bitewings - four radiographic images |
160 |
151 |
$5K |
| D0272 |
Bitewings - two radiographic images |
143 |
138 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
12 |
$3K |
| D1110 |
Prophylaxis - adult |
55 |
55 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
16 |
$558.06 |
| D0603 |
|
320 |
308 |
$0.00 |
| D0602 |
|
154 |
151 |
$0.00 |
| D0601 |
|
77 |
77 |
$0.00 |