| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,173 |
950 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
3,803 |
3,675 |
$103K |
| D1120 |
Prophylaxis - child |
2,459 |
2,376 |
$84K |
| D1110 |
Prophylaxis - adult |
1,583 |
1,523 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,182 |
4,036 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,936 |
1,854 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
4,532 |
4,344 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,532 |
4,187 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,593 |
1,541 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
173 |
168 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
103 |
56 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
85 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
182 |
171 |
$6K |
| D0330 |
Panoramic radiographic image |
490 |
454 |
$4K |
| D0602 |
|
4,379 |
4,270 |
$0.12 |
| D0603 |
|
156 |
149 |
$0.00 |