| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,983 |
1,556 |
$186K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,891 |
865 |
$182K |
| D0145 |
Oral evaluation for a patient under three years of age |
911 |
905 |
$127K |
| D1120 |
Prophylaxis - child |
3,534 |
3,484 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
4,164 |
4,085 |
$115K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,480 |
4,447 |
$101K |
| D1110 |
Prophylaxis - adult |
1,795 |
1,760 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,431 |
5,337 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,014 |
1,966 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
4,726 |
4,621 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
810 |
801 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,337 |
1,313 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,157 |
991 |
$30K |
| D0272 |
Bitewings - two radiographic images |
977 |
962 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
257 |
148 |
$20K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
56 |
26 |
$8K |
| D0330 |
Panoramic radiographic image |
39 |
37 |
$591.20 |
| D0603 |
|
3,964 |
3,881 |
$9.05 |
| D0602 |
|
2,570 |
2,524 |
$0.03 |