| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,584 |
980 |
$121K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
907 |
448 |
$84K |
| D1120 |
Prophylaxis - child |
1,872 |
1,859 |
$63K |
| D1110 |
Prophylaxis - adult |
1,042 |
1,036 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,002 |
1,977 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,728 |
2,706 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,223 |
3,190 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,389 |
1,374 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,909 |
2,862 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
981 |
973 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
232 |
229 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
378 |
256 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
251 |
249 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
580 |
546 |
$14K |
| D0272 |
Bitewings - two radiographic images |
474 |
472 |
$11K |
| D0602 |
|
718 |
706 |
$0.00 |
| D0601 |
|
13 |
12 |
$0.00 |
| D0603 |
|
2,582 |
2,559 |
$0.00 |