| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
411 |
394 |
$55K |
| D1120 |
Prophylaxis - child |
799 |
780 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
913 |
890 |
$25K |
| D1351 |
Sealant - per tooth |
933 |
190 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
237 |
111 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,247 |
1,405 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,397 |
1,366 |
$19K |
| D1110 |
Prophylaxis - adult |
348 |
338 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,544 |
1,479 |
$16K |
| D0274 |
Bitewings - four radiographic images |
463 |
448 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
359 |
351 |
$11K |
| D0272 |
Bitewings - two radiographic images |
395 |
387 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
48 |
$7K |
| D0330 |
Panoramic radiographic image |
145 |
144 |
$3K |
| D0603 |
|
1,136 |
1,111 |
$33.01 |
| D0601 |
|
453 |
434 |
$0.01 |
| D0602 |
|
254 |
251 |
$0.00 |