| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
5,590 |
1,035 |
$129K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,490 |
660 |
$120K |
| D0145 |
Oral evaluation for a patient under three years of age |
987 |
948 |
$119K |
| D1120 |
Prophylaxis - child |
2,387 |
2,259 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
3,074 |
2,846 |
$74K |
| D1110 |
Prophylaxis - adult |
1,391 |
1,276 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,041 |
1,939 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
665 |
358 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,703 |
1,553 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,037 |
2,881 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,797 |
3,539 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,055 |
3,505 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
762 |
706 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
34 |
$2K |
| D1206 |
Topical application of fluoride varnish |
148 |
128 |
$2K |
| D0330 |
Panoramic radiographic image |
34 |
31 |
$667.01 |
| D0603 |
|
1,160 |
1,120 |
$0.02 |
| D0601 |
|
2,854 |
2,728 |
$0.01 |
| D0602 |
|
319 |
306 |
$0.00 |