| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,997 |
1,948 |
$54K |
| D1110 |
Prophylaxis - adult |
1,045 |
1,017 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,975 |
1,809 |
$44K |
| D1120 |
Prophylaxis - child |
1,058 |
1,037 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,188 |
2,139 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,847 |
1,803 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
174 |
168 |
$22K |
| D0272 |
Bitewings - two radiographic images |
933 |
923 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
134 |
65 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
187 |
180 |
$11K |
| D0274 |
Bitewings - four radiographic images |
297 |
285 |
$9K |
| D1351 |
Sealant - per tooth |
266 |
57 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
29 |
$4K |
| D0603 |
|
1,000 |
975 |
$0.00 |
| D0602 |
|
1,337 |
1,314 |
$0.00 |
| D0601 |
|
143 |
142 |
$0.00 |