| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
939 |
929 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,432 |
683 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
3,562 |
3,509 |
$96K |
| D1120 |
Prophylaxis - child |
2,618 |
2,583 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,141 |
3,187 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,079 |
4,022 |
$56K |
| D1110 |
Prophylaxis - adult |
1,073 |
1,056 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,306 |
1,272 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,448 |
3,374 |
$40K |
| D1351 |
Sealant - per tooth |
1,328 |
348 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
369 |
361 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
201 |
131 |
$14K |
| D0272 |
Bitewings - two radiographic images |
307 |
303 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
136 |
131 |
$4K |
| D0330 |
Panoramic radiographic image |
18 |
17 |
$308.74 |
| D0603 |
|
2,606 |
2,566 |
$0.08 |
| D0602 |
|
2,662 |
2,636 |
$0.08 |
| D0601 |
|
17 |
17 |
$0.00 |