| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
677 |
667 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
1,850 |
1,719 |
$46K |
| D1110 |
Prophylaxis - adult |
994 |
903 |
$41K |
| D1120 |
Prophylaxis - child |
1,236 |
1,180 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
450 |
182 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,113 |
1,007 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,133 |
2,106 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,964 |
1,841 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,397 |
2,216 |
$24K |
| D0272 |
Bitewings - two radiographic images |
534 |
504 |
$11K |
| D1351 |
Sealant - per tooth |
500 |
113 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
269 |
233 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
26 |
$4K |
| D0603 |
|
3,001 |
2,898 |
$0.00 |