| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
2,987 |
969 |
$29K |
| D1120 |
Prophylaxis - child |
698 |
657 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
834 |
791 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
265 |
100 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,184 |
1,114 |
$15K |
| D1351 |
Sealant - per tooth |
548 |
110 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,121 |
1,050 |
$12K |
| D1110 |
Prophylaxis - adult |
262 |
253 |
$12K |
| D0274 |
Bitewings - four radiographic images |
376 |
355 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
89 |
81 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
37 |
$2K |
| D0272 |
Bitewings - two radiographic images |
18 |
17 |
$397.46 |
| D0350 |
|
15 |
12 |
$110.28 |
| D0603 |
|
460 |
442 |
$0.00 |
| D0602 |
|
872 |
846 |
$0.00 |
| D0601 |
|
54 |
48 |
$0.00 |