| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
9,844 |
2,726 |
$270K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,488 |
896 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
4,916 |
4,870 |
$140K |
| D1110 |
Prophylaxis - adult |
2,449 |
2,416 |
$132K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,616 |
1,014 |
$126K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,947 |
4,891 |
$102K |
| D1120 |
Prophylaxis - child |
2,520 |
2,502 |
$92K |
| D0274 |
Bitewings - four radiographic images |
2,358 |
2,331 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,011 |
4,961 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
4,945 |
4,903 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,543 |
2,528 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,919 |
1,855 |
$50K |
| D0145 |
Oral evaluation for a patient under three years of age |
332 |
331 |
$47K |
| D0602 |
|
3,971 |
3,940 |
$0.00 |
| D0603 |
|
1,510 |
1,503 |
$0.00 |