| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,050 |
1,017 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
4,126 |
3,993 |
$110K |
| D1120 |
Prophylaxis - child |
3,139 |
3,033 |
$107K |
| D1351 |
Sealant - per tooth |
3,897 |
769 |
$103K |
| D1110 |
Prophylaxis - adult |
1,417 |
1,375 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,591 |
4,440 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
579 |
366 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,726 |
1,677 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
600 |
600 |
$41K |
| D0272 |
Bitewings - two radiographic images |
2,246 |
2,170 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,193 |
3,076 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,970 |
2,774 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
349 |
204 |
$21K |
| D0330 |
Panoramic radiographic image |
1,044 |
1,013 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
288 |
281 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
38 |
$619.74 |
| D0603 |
|
3,820 |
3,684 |
$0.00 |
| D0601 |
|
1,565 |
1,489 |
$0.00 |
| D0602 |
|
307 |
280 |
$0.00 |