| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,613 |
1,060 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,002 |
460 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
2,597 |
2,524 |
$67K |
| D0145 |
Oral evaluation for a patient under three years of age |
472 |
467 |
$60K |
| D1120 |
Prophylaxis - child |
1,680 |
1,636 |
$54K |
| D1110 |
Prophylaxis - adult |
1,133 |
1,091 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,309 |
1,275 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,827 |
2,744 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,244 |
2,376 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,520 |
2,404 |
$29K |
| D0272 |
Bitewings - two radiographic images |
820 |
798 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
260 |
255 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
28 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
42 |
38 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
12 |
$406.65 |
| D0140 |
Limited oral evaluation - problem focused |
30 |
28 |
$244.14 |
| D0603 |
|
3,486 |
3,388 |
$0.00 |