| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
5,003 |
1,435 |
$50K |
| D1120 |
Prophylaxis - child |
978 |
950 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,160 |
1,126 |
$31K |
| D1351 |
Sealant - per tooth |
1,342 |
202 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,422 |
1,383 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,547 |
1,490 |
$18K |
| D1110 |
Prophylaxis - adult |
325 |
315 |
$16K |
| D0274 |
Bitewings - four radiographic images |
431 |
410 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
124 |
42 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
65 |
65 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
24 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
92 |
87 |
$3K |
| D0272 |
Bitewings - two radiographic images |
87 |
86 |
$2K |
| D0602 |
|
55 |
55 |
$0.00 |
| D0603 |
|
1,711 |
1,606 |
$0.00 |