| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,609 |
565 |
$117K |
| D0145 |
Oral evaluation for a patient under three years of age |
605 |
600 |
$79K |
| D1110 |
Prophylaxis - adult |
1,166 |
1,151 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
535 |
189 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
509 |
250 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,508 |
1,485 |
$41K |
| D1120 |
Prophylaxis - child |
1,218 |
1,196 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,490 |
2,451 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,014 |
972 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,530 |
1,998 |
$28K |
| D0274 |
Bitewings - four radiographic images |
925 |
909 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
492 |
486 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,265 |
2,183 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
239 |
148 |
$18K |
| D0272 |
Bitewings - two radiographic images |
709 |
697 |
$13K |
| D0330 |
Panoramic radiographic image |
771 |
745 |
$12K |
| D0603 |
|
2,395 |
2,345 |
$126.00 |
| D0601 |
|
618 |
601 |
$0.00 |
| D0602 |
|
121 |
119 |
$0.00 |
| D3120 |
|
27 |
12 |
$0.00 |