| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
14,269 |
3,552 |
$392K |
| D0120 |
Periodic oral evaluation - established patient |
7,967 |
7,893 |
$227K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,498 |
1,484 |
$210K |
| D1120 |
Prophylaxis - child |
4,965 |
4,923 |
$180K |
| D1110 |
Prophylaxis - adult |
3,322 |
3,285 |
$179K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,225 |
7,597 |
$158K |
| D0272 |
Bitewings - two radiographic images |
5,970 |
5,927 |
$137K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,655 |
8,556 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,021 |
709 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
8,096 |
7,996 |
$100K |
| D0274 |
Bitewings - four radiographic images |
1,247 |
1,230 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
594 |
580 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,207 |
1,166 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
269 |
226 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
503 |
491 |
$17K |
| D1330 |
|
132 |
132 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$488.28 |
| D0602 |
|
1,868 |
1,853 |
$0.00 |
| D0603 |
|
8,254 |
8,177 |
$0.00 |