| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,645 |
1,631 |
$46K |
| D1110 |
Prophylaxis - adult |
820 |
810 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,101 |
1,089 |
$37K |
| D1120 |
Prophylaxis - child |
854 |
848 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
291 |
127 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,250 |
2,231 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,918 |
1,901 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,280 |
2,116 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
89 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
394 |
390 |
$13K |
| D1351 |
Sealant - per tooth |
185 |
38 |
$5K |
| D0272 |
Bitewings - two radiographic images |
193 |
192 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$4K |
| D0603 |
|
1,833 |
1,823 |
$0.25 |
| D0602 |
|
283 |
282 |
$0.04 |
| D0601 |
|
56 |
55 |
$0.00 |