| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
499 |
493 |
$68K |
| D1351 |
Sealant - per tooth |
1,580 |
258 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
339 |
141 |
$27K |
| D1110 |
Prophylaxis - adult |
549 |
526 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,799 |
1,386 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
920 |
896 |
$24K |
| D1120 |
Prophylaxis - child |
725 |
698 |
$24K |
| D0274 |
Bitewings - four radiographic images |
767 |
728 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,322 |
1,266 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,572 |
1,479 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
480 |
433 |
$14K |
| D0330 |
Panoramic radiographic image |
110 |
102 |
$4K |
| D0272 |
Bitewings - two radiographic images |
160 |
157 |
$3K |
| D0601 |
|
521 |
513 |
$0.00 |
| D0603 |
|
1,178 |
1,134 |
$0.00 |
| D0602 |
|
75 |
75 |
$0.00 |