| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
484 |
481 |
$18K |
| D1351 |
Sealant - per tooth |
558 |
88 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
105 |
104 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
469 |
465 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
770 |
761 |
$11K |
| D1110 |
Prophylaxis - adult |
180 |
177 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92 |
39 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
113 |
113 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
217 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
620 |
479 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
515 |
504 |
$6K |
| D0272 |
Bitewings - two radiographic images |
229 |
225 |
$5K |
| D0274 |
Bitewings - four radiographic images |
90 |
90 |
$3K |
| D0601 |
|
75 |
75 |
$0.00 |
| D0603 |
|
403 |
397 |
$0.00 |
| D0602 |
|
286 |
283 |
$0.00 |