| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,130 |
1,119 |
$146K |
| D1351 |
Sealant - per tooth |
2,991 |
542 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,846 |
2,814 |
$75K |
| D1120 |
Prophylaxis - child |
2,180 |
2,157 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,346 |
3,302 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,614 |
3,155 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,830 |
1,807 |
$38K |
| D1110 |
Prophylaxis - adult |
757 |
746 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,310 |
3,263 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
358 |
204 |
$32K |
| D0274 |
Bitewings - four radiographic images |
773 |
765 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
173 |
111 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
248 |
246 |
$8K |
| D0330 |
Panoramic radiographic image |
131 |
130 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$874.41 |
| D0603 |
|
3,185 |
3,139 |
$63.05 |
| D0601 |
|
1,116 |
1,088 |
$0.00 |