| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,106 |
907 |
$110K |
| D0145 |
Oral evaluation for a patient under three years of age |
821 |
810 |
$88K |
| D1110 |
Prophylaxis - adult |
1,788 |
1,750 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,587 |
2,540 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
962 |
406 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,612 |
1,579 |
$44K |
| D1120 |
Prophylaxis - child |
1,336 |
1,327 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
544 |
266 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,625 |
2,303 |
$31K |
| D1206 |
Topical application of fluoride varnish |
2,545 |
2,528 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,587 |
2,520 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
866 |
843 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
462 |
459 |
$21K |
| D0330 |
Panoramic radiographic image |
87 |
87 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
25 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
66 |
58 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
39 |
$1K |
| D0272 |
Bitewings - two radiographic images |
61 |
61 |
$935.20 |
| D0601 |
|
2,490 |
2,464 |
$12.00 |
| D0603 |
|
956 |
938 |
$1.02 |
| D0602 |
|
786 |
775 |
$0.00 |