| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
7,040 |
1,471 |
$197K |
| D1120 |
Prophylaxis - child |
2,962 |
2,952 |
$95K |
| D1206 |
Topical application of fluoride varnish |
4,054 |
4,042 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
3,355 |
3,349 |
$75K |
| D1110 |
Prophylaxis - adult |
1,189 |
1,187 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,371 |
1,366 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,816 |
1,813 |
$33K |
| D0602 |
|
2,005 |
1,998 |
$20K |
| D1330 |
|
3,972 |
3,961 |
$20K |
| D0603 |
|
1,904 |
1,900 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
349 |
348 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,391 |
1,385 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
564 |
559 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,220 |
1,218 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
135 |
96 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
110 |
83 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
235 |
235 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$981.60 |