| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
617 |
109 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
315 |
290 |
$8K |
| D1120 |
Prophylaxis - child |
246 |
225 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
363 |
340 |
$5K |
| D0330 |
Panoramic radiographic image |
151 |
137 |
$4K |
| D0350 |
|
222 |
199 |
$4K |
| D1110 |
Prophylaxis - adult |
76 |
74 |
$4K |
| D0272 |
Bitewings - two radiographic images |
168 |
157 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
384 |
350 |
$3K |
| D0274 |
Bitewings - four radiographic images |
125 |
114 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
358 |
328 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
15 |
$2K |
| D1330 |
|
248 |
215 |
$2K |
| D0603 |
|
330 |
301 |
$0.00 |
| D0601 |
|
13 |
12 |
$0.00 |