| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,445 |
542 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,318 |
2,274 |
$64K |
| D1120 |
Prophylaxis - child |
1,468 |
1,442 |
$52K |
| D1110 |
Prophylaxis - adult |
881 |
866 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,209 |
2,538 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
423 |
214 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,287 |
1,263 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,544 |
2,499 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,697 |
2,637 |
$31K |
| D0272 |
Bitewings - two radiographic images |
561 |
553 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
156 |
93 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
83 |
79 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
152 |
148 |
$5K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$558.62 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$325.32 |
| D0603 |
|
3,030 |
2,989 |
$0.00 |
| D1999 |
|
487 |
480 |
$0.00 |