| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
394 |
392 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
421 |
164 |
$43K |
| D1351 |
Sealant - per tooth |
1,080 |
161 |
$29K |
| D1110 |
Prophylaxis - adult |
519 |
514 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
724 |
703 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,266 |
1,243 |
$17K |
| D1120 |
Prophylaxis - child |
480 |
466 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,273 |
1,093 |
$16K |
| D0274 |
Bitewings - four radiographic images |
470 |
462 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,149 |
1,126 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
284 |
275 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
36 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
111 |
111 |
$6K |
| D0272 |
Bitewings - two radiographic images |
90 |
86 |
$2K |
| D0330 |
Panoramic radiographic image |
174 |
169 |
$1K |
| D0603 |
|
807 |
791 |
$18.02 |
| D0601 |
|
738 |
726 |
$0.00 |