| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
11,332 |
2,397 |
$300K |
| D0120 |
Periodic oral evaluation - established patient |
8,958 |
8,811 |
$248K |
| D1110 |
Prophylaxis - adult |
4,570 |
4,499 |
$236K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,630 |
1,603 |
$223K |
| D1120 |
Prophylaxis - child |
5,755 |
5,641 |
$202K |
| D0274 |
Bitewings - four radiographic images |
5,154 |
5,075 |
$146K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,162 |
9,991 |
$143K |
| D0220 |
Intraoral - periapical first radiographic image |
11,017 |
10,795 |
$117K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,381 |
10,174 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,007 |
669 |
$94K |
| D0272 |
Bitewings - two radiographic images |
4,257 |
4,184 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
797 |
797 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,477 |
1,435 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
294 |
230 |
$22K |
| D0330 |
Panoramic radiographic image |
2,080 |
2,035 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
712 |
642 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
240 |
235 |
$4K |
| D1206 |
Topical application of fluoride varnish |
58 |
56 |
$748.23 |
| D0270 |
|
50 |
49 |
$220.01 |
| D0602 |
|
8,588 |
8,456 |
$0.35 |
| D0601 |
|
100 |
98 |
$0.11 |
| D0603 |
|
3,432 |
3,350 |
$0.06 |