| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
499 |
491 |
$61K |
| D1120 |
Prophylaxis - child |
1,676 |
1,655 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,850 |
1,817 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,258 |
1,242 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,152 |
2,122 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
321 |
153 |
$29K |
| D1110 |
Prophylaxis - adult |
457 |
443 |
$22K |
| D0274 |
Bitewings - four radiographic images |
617 |
599 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,404 |
1,375 |
$17K |
| D1351 |
Sealant - per tooth |
513 |
51 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
182 |
177 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
245 |
237 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
27 |
$4K |
| D0272 |
Bitewings - two radiographic images |
156 |
153 |
$3K |
| D0601 |
|
593 |
574 |
$0.00 |
| D0602 |
|
990 |
973 |
$0.00 |
| D0603 |
|
1,086 |
1,077 |
$0.00 |