| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,112 |
2,080 |
$59K |
| D1110 |
Prophylaxis - adult |
1,053 |
1,039 |
$56K |
| D0145 |
Oral evaluation for a patient under three years of age |
332 |
331 |
$46K |
| D1120 |
Prophylaxis - child |
1,295 |
1,278 |
$46K |
| D1351 |
Sealant - per tooth |
1,424 |
230 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,395 |
2,354 |
$34K |
| D0274 |
Bitewings - four radiographic images |
996 |
983 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,314 |
2,272 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,296 |
2,197 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,126 |
1,109 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
49 |
48 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
96 |
95 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
17 |
$3K |
| D0330 |
Panoramic radiographic image |
25 |
22 |
$1K |
| D0603 |
|
1,128 |
1,102 |
$0.00 |
| D0602 |
|
1,530 |
1,509 |
$0.00 |