| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
971 |
960 |
$135K |
| D1110 |
Prophylaxis - adult |
2,004 |
1,893 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
3,676 |
3,493 |
$91K |
| D1120 |
Prophylaxis - child |
1,860 |
1,801 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,035 |
1,915 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
591 |
401 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,705 |
3,548 |
$50K |
| D0330 |
Panoramic radiographic image |
933 |
870 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,214 |
1,165 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
547 |
507 |
$16K |
| D1351 |
Sealant - per tooth |
614 |
131 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
221 |
161 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,054 |
947 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
70 |
67 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
143 |
57 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$236.90 |
| D0601 |
|
2,329 |
2,282 |
$0.00 |
| D0603 |
|
2,009 |
1,946 |
$0.00 |
| D0602 |
|
769 |
746 |
$0.00 |