| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
10,008 |
1,787 |
$262K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,397 |
1,389 |
$194K |
| D0120 |
Periodic oral evaluation - established patient |
6,415 |
6,348 |
$174K |
| D1120 |
Prophylaxis - child |
4,646 |
4,602 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,491 |
829 |
$144K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,742 |
6,154 |
$135K |
| D1110 |
Prophylaxis - adult |
2,247 |
2,227 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,347 |
683 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,912 |
6,846 |
$96K |
| D0220 |
Intraoral - periapical first radiographic image |
6,736 |
6,600 |
$78K |
| D0274 |
Bitewings - four radiographic images |
2,200 |
2,172 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,191 |
2,073 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
761 |
757 |
$49K |
| D0272 |
Bitewings - two radiographic images |
1,969 |
1,953 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
371 |
364 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
75 |
$1K |
| D0603 |
|
9,167 |
9,092 |
$0.01 |