| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,365 |
570 |
$78K |
| D1120 |
Prophylaxis - child |
2,055 |
1,948 |
$67K |
| D0145 |
Oral evaluation for a patient under three years of age |
470 |
460 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,042 |
1,953 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,334 |
2,218 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,356 |
1,261 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
316 |
287 |
$10K |
| D9248 |
|
101 |
78 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
123 |
41 |
$9K |
| D0274 |
Bitewings - four radiographic images |
218 |
205 |
$7K |
| D1110 |
Prophylaxis - adult |
110 |
110 |
$6K |
| D0330 |
Panoramic radiographic image |
70 |
68 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
197 |
173 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
77 |
62 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
124 |
105 |
$1K |
| D0602 |
|
2,851 |
2,773 |
$0.00 |
| D0603 |
|
203 |
181 |
$0.00 |
| D0601 |
|
63 |
63 |
$0.00 |