| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
720 |
696 |
$19K |
| D1120 |
Prophylaxis - child |
467 |
448 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,472 |
894 |
$15K |
| D1110 |
Prophylaxis - adult |
280 |
268 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
946 |
909 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,035 |
972 |
$11K |
| D0274 |
Bitewings - four radiographic images |
279 |
263 |
$8K |
| D1351 |
Sealant - per tooth |
342 |
52 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
30 |
30 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
87 |
$3K |
| D0272 |
Bitewings - two radiographic images |
104 |
103 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
14 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
22 |
22 |
$1K |
| D0603 |
|
1,206 |
1,167 |
$0.00 |