| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
62 |
57 |
$7K |
| D1110 |
Prophylaxis - adult |
129 |
124 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
218 |
212 |
$5K |
| D0330 |
Panoramic radiographic image |
115 |
113 |
$5K |
| D1120 |
Prophylaxis - child |
135 |
132 |
$4K |
| D0274 |
Bitewings - four radiographic images |
123 |
118 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
257 |
249 |
$3K |
| D0272 |
Bitewings - two radiographic images |
123 |
119 |
$2K |
| D1351 |
Sealant - per tooth |
93 |
13 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
52 |
48 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
76 |
70 |
$643.08 |
| D0230 |
Intraoral - periapical each additional radiographic image |
71 |
41 |
$369.54 |
| D0601 |
|
252 |
245 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |
| D0603 |
|
49 |
47 |
$0.00 |