| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,346 |
673 |
$97K |
| D0145 |
Oral evaluation for a patient under three years of age |
492 |
481 |
$64K |
| D1120 |
Prophylaxis - child |
1,782 |
1,671 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,525 |
1,484 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,025 |
2,186 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,175 |
2,050 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,493 |
1,407 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
279 |
145 |
$26K |
| D1110 |
Prophylaxis - adult |
550 |
533 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
890 |
782 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,684 |
2,508 |
$22K |
| D0330 |
Panoramic radiographic image |
803 |
699 |
$17K |
| D0274 |
Bitewings - four radiographic images |
630 |
567 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
89 |
54 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
97 |
90 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
33 |
$582.18 |
| D0350 |
|
143 |
123 |
$66.76 |
| D0603 |
|
2,418 |
2,316 |
$0.00 |
| D1310 |
|
184 |
148 |
$0.00 |
| D0602 |
|
620 |
598 |
$0.00 |