| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
899 |
841 |
$115K |
| D1110 |
Prophylaxis - adult |
1,649 |
1,499 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,628 |
2,441 |
$67K |
| D1120 |
Prophylaxis - child |
1,550 |
1,475 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,610 |
1,458 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,908 |
2,762 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,334 |
2,231 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,147 |
1,108 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,309 |
2,190 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
378 |
336 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
38 |
$6K |
| D1351 |
Sealant - per tooth |
109 |
25 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
24 |
$2K |
| D0602 |
|
3,502 |
3,387 |
$0.00 |
| D0601 |
|
266 |
259 |
$0.00 |