| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,236 |
3,196 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,373 |
3,328 |
$48K |
| D1110 |
Prophylaxis - adult |
882 |
874 |
$47K |
| D1120 |
Prophylaxis - child |
1,303 |
1,288 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
439 |
267 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,720 |
2,929 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,121 |
3,072 |
$37K |
| D0274 |
Bitewings - four radiographic images |
965 |
956 |
$30K |
| D0145 |
Oral evaluation for a patient under three years of age |
102 |
99 |
$14K |
| D0272 |
Bitewings - two radiographic images |
484 |
482 |
$11K |
| D1351 |
Sealant - per tooth |
405 |
100 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
37 |
$4K |
| D0602 |
|
1,840 |
1,821 |
$0.00 |
| D0603 |
|
1,185 |
1,180 |
$0.00 |
| D0601 |
|
15 |
14 |
$0.00 |