| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,287 |
1,274 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
4,672 |
4,609 |
$132K |
| D1120 |
Prophylaxis - child |
3,344 |
3,284 |
$119K |
| D1110 |
Prophylaxis - adult |
1,825 |
1,786 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,083 |
5,003 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,021 |
1,982 |
$65K |
| D0272 |
Bitewings - two radiographic images |
2,921 |
2,882 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
5,278 |
5,164 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,983 |
4,890 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
377 |
205 |
$36K |
| D1351 |
Sealant - per tooth |
639 |
108 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
216 |
165 |
$16K |
| D0330 |
Panoramic radiographic image |
461 |
448 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
254 |
241 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
108 |
106 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$281.70 |
| D0602 |
|
314 |
314 |
$0.00 |
| D0603 |
|
5,871 |
5,804 |
$0.00 |