| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
8,127 |
1,174 |
$205K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,523 |
835 |
$117K |
| D0274 |
Bitewings - four radiographic images |
3,565 |
3,401 |
$109K |
| D1120 |
Prophylaxis - child |
2,566 |
2,452 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
3,373 |
3,228 |
$75K |
| D1206 |
Topical application of fluoride varnish |
3,772 |
3,563 |
$68K |
| D1110 |
Prophylaxis - adult |
1,467 |
1,391 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
752 |
436 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
4,033 |
3,835 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,925 |
3,736 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,457 |
1,251 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
465 |
438 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
50 |
50 |
$1K |