| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
500 |
489 |
$66K |
| D1120 |
Prophylaxis - child |
204 |
192 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
707 |
239 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
198 |
184 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
303 |
286 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
15 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
297 |
278 |
$3K |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$888.42 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$777.04 |
| D0603 |
|
762 |
736 |
$0.17 |
| D0602 |
|
99 |
96 |
$0.00 |