| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,994 |
1,946 |
$54K |
| D1120 |
Prophylaxis - child |
1,398 |
1,370 |
$48K |
| D1110 |
Prophylaxis - adult |
833 |
807 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,202 |
1,164 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
320 |
207 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,210 |
2,161 |
$30K |
| D1351 |
Sealant - per tooth |
887 |
112 |
$23K |
| D0330 |
Panoramic radiographic image |
409 |
401 |
$17K |
| D0272 |
Bitewings - two radiographic images |
361 |
358 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
138 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
26 |
$3K |
| D0601 |
|
266 |
266 |
$0.00 |
| D0602 |
|
1,360 |
1,328 |
$0.00 |
| D0603 |
|
378 |
377 |
$0.00 |