| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,888 |
695 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
2,795 |
2,774 |
$79K |
| D0145 |
Oral evaluation for a patient under three years of age |
508 |
504 |
$71K |
| D1110 |
Prophylaxis - adult |
1,215 |
1,212 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,978 |
1,968 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,518 |
2,618 |
$62K |
| D1120 |
Prophylaxis - child |
1,614 |
1,600 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,880 |
2,862 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,700 |
2,678 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
315 |
209 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
523 |
482 |
$13K |
| D0272 |
Bitewings - two radiographic images |
485 |
480 |
$11K |
| D0603 |
|
3,462 |
3,434 |
$66.02 |
| D1999 |
|
404 |
378 |
$20.00 |
| D0601 |
|
55 |
52 |
$0.00 |
| D0602 |
|
111 |
107 |
$0.00 |