| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
599 |
590 |
$79K |
| D1120 |
Prophylaxis - child |
1,372 |
1,327 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,604 |
1,550 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
425 |
199 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,657 |
1,664 |
$37K |
| D1351 |
Sealant - per tooth |
1,854 |
303 |
$37K |
| D1110 |
Prophylaxis - adult |
595 |
560 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,922 |
1,851 |
$25K |
| D0274 |
Bitewings - four radiographic images |
848 |
813 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,957 |
1,824 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
476 |
450 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
164 |
81 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
17 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
60 |
$3K |
| D0272 |
Bitewings - two radiographic images |
81 |
79 |
$2K |
| D0603 |
|
1,853 |
1,796 |
$0.01 |
| D0601 |
|
1,024 |
1,001 |
$0.00 |