| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
7,279 |
1,273 |
$140K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,259 |
1,246 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,639 |
699 |
$119K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,428 |
4,216 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
3,899 |
3,829 |
$86K |
| D1120 |
Prophylaxis - child |
3,071 |
3,020 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,126 |
495 |
$57K |
| D1110 |
Prophylaxis - adult |
1,300 |
1,272 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,932 |
1,886 |
$48K |
| D1206 |
Topical application of fluoride varnish |
4,404 |
4,332 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
4,573 |
4,412 |
$40K |
| D0272 |
Bitewings - two radiographic images |
774 |
760 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
418 |
413 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
121 |
113 |
$2K |
| D0330 |
Panoramic radiographic image |
21 |
21 |
$617.55 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$565.57 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
26 |
$349.63 |
| D0603 |
|
3,697 |
3,643 |
$0.05 |
| D0601 |
|
1,601 |
1,581 |
$0.01 |
| D0602 |
|
324 |
315 |
$0.00 |