| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
16,654 |
3,337 |
$409K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,095 |
2,017 |
$274K |
| D0120 |
Periodic oral evaluation - established patient |
9,233 |
8,942 |
$248K |
| D1110 |
Prophylaxis - adult |
4,548 |
4,382 |
$229K |
| D1120 |
Prophylaxis - child |
6,598 |
6,404 |
$225K |
| D1206 |
Topical application of fluoride varnish |
11,001 |
10,648 |
$150K |
| D0210 |
Intraoral - complete series of radiographic images |
2,216 |
2,111 |
$139K |
| D0274 |
Bitewings - four radiographic images |
4,213 |
4,098 |
$137K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,150 |
617 |
$96K |
| D0272 |
Bitewings - two radiographic images |
3,936 |
3,832 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
867 |
468 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,919 |
1,826 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
313 |
288 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
90 |
84 |
$905.84 |
| D1208 |
Topical application of fluoride, excluding varnish |
60 |
58 |
$779.10 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$430.06 |
| D0602 |
|
7,101 |
6,949 |
$0.00 |
| D0603 |
|
3,263 |
3,196 |
$0.00 |
| D0601 |
|
2,691 |
2,592 |
$0.00 |