| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
738 |
726 |
$20K |
| D1120 |
Prophylaxis - child |
559 |
547 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
141 |
47 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
89 |
85 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
783 |
770 |
$11K |
| D1351 |
Sealant - per tooth |
478 |
94 |
$11K |
| D0274 |
Bitewings - four radiographic images |
355 |
345 |
$10K |
| D1110 |
Prophylaxis - adult |
180 |
178 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
697 |
683 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
645 |
633 |
$7K |
| D0272 |
Bitewings - two radiographic images |
247 |
245 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
14 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
36 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$423.84 |
| D0603 |
|
856 |
843 |
$0.00 |