| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
7,386 |
1,395 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
3,870 |
3,839 |
$108K |
| D1120 |
Prophylaxis - child |
2,503 |
2,487 |
$89K |
| D1110 |
Prophylaxis - adult |
1,625 |
1,605 |
$86K |
| D0145 |
Oral evaluation for a patient under three years of age |
532 |
525 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,109 |
4,078 |
$59K |
| D0272 |
Bitewings - two radiographic images |
2,402 |
2,394 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,040 |
4,000 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,343 |
3,796 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
501 |
494 |
$33K |
| D0274 |
Bitewings - four radiographic images |
720 |
707 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
276 |
157 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
217 |
108 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
218 |
209 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
92 |
90 |
$3K |
| D0330 |
Panoramic radiographic image |
50 |
50 |
$279.06 |
| D0602 |
|
692 |
690 |
$0.00 |
| D0603 |
|
4,041 |
4,006 |
$0.00 |