| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,125 |
1,112 |
$32K |
| D1110 |
Prophylaxis - adult |
482 |
476 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,248 |
1,238 |
$18K |
| D1120 |
Prophylaxis - child |
467 |
463 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,598 |
1,190 |
$16K |
| D0274 |
Bitewings - four radiographic images |
459 |
452 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,281 |
1,264 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
100 |
96 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
119 |
53 |
$12K |
| D0272 |
Bitewings - two radiographic images |
326 |
323 |
$7K |
| D1351 |
Sealant - per tooth |
195 |
29 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
31 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31 |
31 |
$1K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$407.84 |
| D0603 |
|
959 |
949 |
$0.00 |
| D0602 |
|
101 |
97 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |