| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
465 |
461 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
476 |
110 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,287 |
1,418 |
$33K |
| D1120 |
Prophylaxis - child |
912 |
895 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,098 |
1,085 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,404 |
1,383 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,547 |
1,499 |
$17K |
| D1110 |
Prophylaxis - adult |
276 |
271 |
$14K |
| D0274 |
Bitewings - four radiographic images |
311 |
306 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
85 |
$3K |
| D0272 |
Bitewings - two radiographic images |
122 |
120 |
$3K |
| D0603 |
|
2,178 |
2,142 |
$0.00 |