| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,308 |
745 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
1,844 |
1,786 |
$49K |
| D1110 |
Prophylaxis - adult |
793 |
761 |
$40K |
| D1120 |
Prophylaxis - child |
1,134 |
1,107 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,927 |
1,615 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
327 |
160 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,916 |
1,858 |
$26K |
| D0274 |
Bitewings - four radiographic images |
735 |
707 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,767 |
1,698 |
$19K |
| D0272 |
Bitewings - two radiographic images |
605 |
590 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
237 |
204 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
42 |
$1K |
| D0330 |
Panoramic radiographic image |
138 |
128 |
$1K |
| D0601 |
|
447 |
439 |
$0.00 |
| D0603 |
|
946 |
917 |
$0.00 |
| D0602 |
|
423 |
416 |
$0.00 |