| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
14,069 |
3,262 |
$354K |
| D0120 |
Periodic oral evaluation - established patient |
9,368 |
9,229 |
$259K |
| D1120 |
Prophylaxis - child |
6,156 |
6,091 |
$216K |
| D1110 |
Prophylaxis - adult |
3,856 |
3,805 |
$201K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,402 |
1,386 |
$191K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,885 |
806 |
$169K |
| D0274 |
Bitewings - four radiographic images |
4,876 |
4,818 |
$160K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,051 |
9,937 |
$142K |
| D0220 |
Intraoral - periapical first radiographic image |
9,451 |
9,331 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,237 |
9,049 |
$101K |
| D0272 |
Bitewings - two radiographic images |
3,335 |
3,308 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
380 |
375 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
197 |
96 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
377 |
365 |
$12K |
| D1330 |
|
212 |
209 |
$2K |
| D9248 |
|
13 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$243.99 |
| D0603 |
|
12,223 |
12,034 |
$81.34 |
| D0601 |
|
116 |
63 |
$0.00 |
| D0602 |
|
73 |
36 |
$0.00 |
| D3120 |
|
24 |
12 |
$0.00 |