| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,468 |
1,285 |
$165K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,191 |
1,161 |
$161K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,375 |
563 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
4,101 |
3,984 |
$112K |
| D1120 |
Prophylaxis - child |
2,883 |
2,799 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,448 |
3,809 |
$78K |
| D1110 |
Prophylaxis - adult |
1,508 |
1,477 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,302 |
4,187 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,432 |
2,384 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
738 |
402 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
4,086 |
3,957 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,443 |
1,408 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
284 |
273 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
216 |
195 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
39 |
37 |
$1K |
| D0603 |
|
3,712 |
3,644 |
$1.10 |
| D0602 |
|
1,969 |
1,904 |
$0.00 |