| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
960 |
945 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
492 |
205 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,121 |
1,100 |
$37K |
| D1110 |
Prophylaxis - adult |
633 |
624 |
$33K |
| D1120 |
Prophylaxis - child |
844 |
834 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,530 |
919 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
800 |
788 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,508 |
1,488 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,022 |
990 |
$12K |
| D1351 |
Sealant - per tooth |
425 |
91 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
92 |
46 |
$7K |
| D1206 |
Topical application of fluoride varnish |
418 |
415 |
$6K |
| D0274 |
Bitewings - four radiographic images |
175 |
175 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
40 |
$6K |
| D0272 |
Bitewings - two radiographic images |
83 |
80 |
$2K |
| D0170 |
|
15 |
15 |
$165.40 |
| D0603 |
|
1,623 |
1,602 |
$18.02 |
| D0602 |
|
408 |
407 |
$0.00 |
| D0601 |
|
16 |
16 |
$0.00 |