| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
849 |
841 |
$116K |
| D1351 |
Sealant - per tooth |
4,403 |
895 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
3,796 |
3,745 |
$106K |
| D1120 |
Prophylaxis - child |
2,895 |
2,843 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
981 |
386 |
$95K |
| D1110 |
Prophylaxis - adult |
1,225 |
1,207 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,129 |
4,058 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,049 |
2,561 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,705 |
1,680 |
$56K |
| D0350 |
|
2,608 |
2,568 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
559 |
278 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,790 |
1,765 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,770 |
2,718 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
189 |
183 |
$6K |
| D0330 |
Panoramic radiographic image |
337 |
327 |
$3K |
| D0603 |
|
5,088 |
5,017 |
$9.09 |