| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,444 |
790 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,874 |
2,795 |
$78K |
| D1110 |
Prophylaxis - adult |
1,503 |
1,462 |
$77K |
| D0274 |
Bitewings - four radiographic images |
1,849 |
1,801 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
825 |
436 |
$59K |
| D1120 |
Prophylaxis - child |
1,530 |
1,491 |
$53K |
| D0145 |
Oral evaluation for a patient under three years of age |
329 |
328 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,044 |
3,021 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,969 |
2,902 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,211 |
3,117 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
396 |
178 |
$35K |
| D0272 |
Bitewings - two radiographic images |
588 |
573 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
189 |
188 |
$6K |
| D0601 |
|
776 |
770 |
$0.00 |
| D0602 |
|
1,766 |
1,737 |
$0.00 |
| D0603 |
|
975 |
949 |
$0.00 |