| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
578 |
573 |
$80K |
| D1120 |
Prophylaxis - child |
673 |
651 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
684 |
659 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,087 |
1,059 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,103 |
1,059 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,071 |
984 |
$12K |
| D0272 |
Bitewings - two radiographic images |
431 |
418 |
$10K |
| D1110 |
Prophylaxis - adult |
142 |
139 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
25 |
$6K |
| D0274 |
Bitewings - four radiographic images |
164 |
159 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
132 |
128 |
$4K |
| D1351 |
Sealant - per tooth |
52 |
15 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
25 |
$507.06 |
| D0350 |
|
18 |
18 |
$18.38 |
| D0601 |
|
847 |
826 |
$0.00 |
| D0603 |
|
159 |
154 |
$0.00 |
| D0602 |
|
225 |
222 |
$0.00 |
| D9986 |
|
17 |
16 |
$0.00 |