| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,407 |
1,376 |
$39K |
| D1110 |
Prophylaxis - adult |
663 |
655 |
$35K |
| D1351 |
Sealant - per tooth |
1,262 |
212 |
$34K |
| D1120 |
Prophylaxis - child |
763 |
746 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,568 |
1,544 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,449 |
1,405 |
$17K |
| D0274 |
Bitewings - four radiographic images |
505 |
499 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,361 |
1,318 |
$15K |
| D0272 |
Bitewings - two radiographic images |
708 |
696 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
100 |
100 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
37 |
$7K |
| D0330 |
Panoramic radiographic image |
59 |
58 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20 |
20 |
$699.34 |
| D0603 |
|
263 |
261 |
$0.00 |
| D0601 |
|
418 |
406 |
$0.00 |
| D0602 |
|
852 |
840 |
$0.00 |