| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,914 |
752 |
$130K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
681 |
298 |
$61K |
| D1110 |
Prophylaxis - adult |
1,051 |
1,037 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,902 |
1,885 |
$53K |
| D1120 |
Prophylaxis - child |
1,423 |
1,410 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,666 |
2,551 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,173 |
1,144 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,289 |
2,264 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,766 |
2,663 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,096 |
1,084 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
109 |
108 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
466 |
457 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
192 |
101 |
$13K |
| D3910 |
|
918 |
173 |
$12K |
| D9248 |
|
117 |
100 |
$10K |
| D0330 |
Panoramic radiographic image |
639 |
630 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
239 |
222 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
70 |
70 |
$4K |
| D0340 |
|
91 |
90 |
$3K |
| D1206 |
Topical application of fluoride varnish |
45 |
43 |
$529.20 |
| D0603 |
|
3,688 |
3,305 |
$0.00 |