| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
17,792 |
3,571 |
$463K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,416 |
1,316 |
$323K |
| D1120 |
Prophylaxis - child |
6,026 |
5,929 |
$214K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,513 |
5,401 |
$180K |
| D1110 |
Prophylaxis - adult |
2,762 |
2,724 |
$147K |
| D0274 |
Bitewings - four radiographic images |
4,187 |
4,133 |
$140K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,920 |
8,773 |
$127K |
| D0145 |
Oral evaluation for a patient under three years of age |
842 |
838 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
8,582 |
8,438 |
$104K |
| D0272 |
Bitewings - two radiographic images |
4,369 |
4,293 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,461 |
3,419 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,278 |
653 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,577 |
8,425 |
$97K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,908 |
1,823 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
153 |
149 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |
| D0601 |
|
9,537 |
9,346 |
$0.00 |
| D0602 |
|
265 |
256 |
$0.00 |