| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
987 |
971 |
$28K |
| D1110 |
Prophylaxis - adult |
321 |
317 |
$17K |
| D0272 |
Bitewings - two radiographic images |
716 |
709 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,081 |
1,070 |
$16K |
| D1120 |
Prophylaxis - child |
361 |
354 |
$13K |
| D1351 |
Sealant - per tooth |
435 |
79 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
124 |
51 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
838 |
825 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
849 |
820 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
33 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
51 |
$3K |
| D0603 |
|
166 |
162 |
$0.00 |
| D0601 |
|
395 |
393 |
$0.00 |
| D0602 |
|
154 |
152 |
$0.00 |