| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,627 |
842 |
$112K |
| D0145 |
Oral evaluation for a patient under three years of age |
618 |
614 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,268 |
2,805 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,379 |
2,364 |
$66K |
| D1110 |
Prophylaxis - adult |
1,245 |
1,238 |
$63K |
| D1120 |
Prophylaxis - child |
1,717 |
1,709 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
672 |
324 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,707 |
2,694 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,183 |
1,180 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,946 |
2,895 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
610 |
576 |
$19K |
| D0272 |
Bitewings - two radiographic images |
801 |
796 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
226 |
151 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
219 |
216 |
$11K |
| D1206 |
Topical application of fluoride varnish |
95 |
93 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$283.10 |
| D0603 |
|
1,824 |
1,804 |
$51.13 |
| D0602 |
|
1,810 |
1,792 |
$9.06 |
| D0601 |
|
49 |
48 |
$0.00 |