| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
5,654 |
1,542 |
$60K |
| D1351 |
Sealant - per tooth |
2,231 |
361 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,532 |
1,466 |
$41K |
| D1120 |
Prophylaxis - child |
1,153 |
1,115 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,753 |
1,681 |
$24K |
| D1110 |
Prophylaxis - adult |
467 |
440 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,734 |
1,644 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
51 |
$13K |
| D0274 |
Bitewings - four radiographic images |
298 |
282 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
27 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
16 |
$2K |
| D0272 |
Bitewings - two radiographic images |
39 |
35 |
$818.30 |
| D0603 |
|
1,537 |
1,485 |
$0.00 |
| D0602 |
|
210 |
206 |
$0.00 |
| D0601 |
|
14 |
13 |
$0.00 |