| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,890 |
1,879 |
$245K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,545 |
686 |
$143K |
| D1351 |
Sealant - per tooth |
5,495 |
1,286 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
4,108 |
4,080 |
$116K |
| D1120 |
Prophylaxis - child |
3,023 |
3,002 |
$107K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,039 |
4,663 |
$100K |
| D1110 |
Prophylaxis - adult |
1,575 |
1,559 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,760 |
4,720 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
776 |
420 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
4,770 |
4,678 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,694 |
1,671 |
$53K |
| D0272 |
Bitewings - two radiographic images |
1,986 |
1,979 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
407 |
395 |
$14K |
| D0330 |
Panoramic radiographic image |
305 |
296 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
12 |
$2K |
| D0603 |
|
2,659 |
2,631 |
$171.00 |
| D0601 |
|
3,580 |
3,556 |
$24.02 |
| D0602 |
|
197 |
194 |
$0.00 |