| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,527 |
1,452 |
$65K |
| D0145 |
Oral evaluation for a patient under three years of age |
538 |
519 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,793 |
2,665 |
$62K |
| D1120 |
Prophylaxis - child |
1,395 |
1,356 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,389 |
1,323 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,791 |
2,704 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
276 |
155 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,100 |
1,060 |
$20K |
| D0330 |
Panoramic radiographic image |
591 |
568 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,343 |
1,275 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,546 |
918 |
$13K |
| D1351 |
Sealant - per tooth |
611 |
102 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
262 |
244 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
74 |
72 |
$5K |
| D0350 |
|
60 |
58 |
$700.82 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$696.46 |
| D0601 |
|
2,321 |
2,279 |
$96.02 |
| D0603 |
|
589 |
573 |
$90.04 |
| D0602 |
|
452 |
447 |
$81.03 |
| D1330 |
|
15 |
15 |
$12.25 |