| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,067 |
566 |
$107K |
| D1110 |
Prophylaxis - adult |
1,977 |
1,940 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
3,652 |
3,590 |
$98K |
| D0274 |
Bitewings - four radiographic images |
2,632 |
2,570 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,770 |
4,084 |
$79K |
| D1120 |
Prophylaxis - child |
1,846 |
1,828 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,813 |
3,756 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
4,684 |
4,470 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
457 |
237 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
578 |
272 |
$41K |
| D0350 |
|
2,420 |
2,382 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
438 |
418 |
$14K |
| D0330 |
Panoramic radiographic image |
452 |
440 |
$8K |
| D0272 |
Bitewings - two radiographic images |
343 |
340 |
$8K |
| D9248 |
|
66 |
63 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
42 |
42 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
48 |
$1K |
| D0603 |
|
4,460 |
4,401 |
$0.00 |