| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,311 |
472 |
$39K |
| D1206 |
Topical application of fluoride varnish |
881 |
823 |
$38K |
| D1120 |
Prophylaxis - child |
801 |
753 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
941 |
361 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,745 |
1,447 |
$31K |
| D0330 |
Panoramic radiographic image |
778 |
741 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,298 |
1,234 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
748 |
709 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
494 |
239 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,281 |
1,200 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
455 |
422 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
404 |
387 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
180 |
81 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
209 |
126 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
25 |
$2K |
| D1353 |
|
66 |
31 |
$1K |
| D0272 |
Bitewings - two radiographic images |
51 |
42 |
$759.24 |
| D7111 |
|
20 |
13 |
$565.80 |
| D5899 |
|
15 |
15 |
$266.50 |