| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,433 |
431 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,947 |
1,938 |
$56K |
| D1120 |
Prophylaxis - child |
1,296 |
1,290 |
$47K |
| D1110 |
Prophylaxis - adult |
701 |
700 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,296 |
1,929 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,068 |
1,067 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,044 |
2,033 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,976 |
1,966 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
117 |
74 |
$12K |
| D0272 |
Bitewings - two radiographic images |
434 |
433 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
156 |
154 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$3K |
| D0603 |
|
2,253 |
2,233 |
$0.00 |