| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
686 |
663 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
2,640 |
2,605 |
$73K |
| D1120 |
Prophylaxis - child |
1,566 |
1,548 |
$54K |
| D1110 |
Prophylaxis - adult |
953 |
936 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,399 |
2,359 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,888 |
2,849 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
1,757 |
1,726 |
$21K |
| D1351 |
Sealant - per tooth |
786 |
154 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
269 |
130 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,638 |
1,585 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
178 |
81 |
$16K |
| D0330 |
Panoramic radiographic image |
390 |
379 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
13 |
$388.52 |
| D0601 |
|
3,474 |
3,392 |
$0.00 |
| D0603 |
|
61 |
60 |
$0.00 |
| D0602 |
|
41 |
38 |
$0.00 |