| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
9,204 |
1,196 |
$308K |
| D1120 |
Prophylaxis - child |
5,494 |
5,397 |
$247K |
| D1206 |
Topical application of fluoride varnish |
9,314 |
9,158 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
7,049 |
6,917 |
$215K |
| D1110 |
Prophylaxis - adult |
2,954 |
2,906 |
$183K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,152 |
570 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,178 |
1,174 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,588 |
2,548 |
$60K |
| D0272 |
Bitewings - two radiographic images |
3,579 |
3,516 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
456 |
243 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
920 |
898 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,250 |
1,204 |
$24K |
| D1330 |
|
3,171 |
3,124 |
$21K |
| D0330 |
Panoramic radiographic image |
327 |
320 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
13 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
156 |
154 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
87 |
86 |
$863.70 |
| D0270 |
|
27 |
27 |
$243.00 |
| D9910 |
|
12 |
12 |
$120.00 |