| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
5,446 |
1,372 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
4,791 |
4,704 |
$134K |
| D0145 |
Oral evaluation for a patient under three years of age |
961 |
939 |
$131K |
| D1120 |
Prophylaxis - child |
3,344 |
3,271 |
$119K |
| D1110 |
Prophylaxis - adult |
1,813 |
1,777 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,132 |
5,019 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,889 |
4,244 |
$65K |
| D0272 |
Bitewings - two radiographic images |
2,797 |
2,737 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
4,580 |
4,450 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,454 |
1,429 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
734 |
711 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
476 |
286 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
419 |
290 |
$32K |
| D9248 |
|
38 |
38 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
109 |
$4K |
| D0602 |
|
1,491 |
1,470 |
$0.00 |
| D0601 |
|
1,916 |
1,867 |
$0.00 |
| D0603 |
|
2,735 |
2,685 |
$0.00 |