| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,891 |
618 |
$75K |
| D0145 |
Oral evaluation for a patient under three years of age |
398 |
396 |
$55K |
| D1120 |
Prophylaxis - child |
1,270 |
1,260 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,529 |
1,480 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
459 |
263 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,811 |
1,721 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,746 |
1,692 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,877 |
1,807 |
$22K |
| D1110 |
Prophylaxis - adult |
427 |
417 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
219 |
118 |
$20K |
| D0272 |
Bitewings - two radiographic images |
918 |
905 |
$20K |
| D0274 |
Bitewings - four radiographic images |
504 |
470 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
559 |
507 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
68 |
$2K |
| D0240 |
|
114 |
62 |
$1K |
| D0602 |
|
1,036 |
1,015 |
$0.00 |
| D0603 |
|
1,118 |
1,093 |
$0.00 |