| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,940 |
1,456 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
4,411 |
4,393 |
$124K |
| D1120 |
Prophylaxis - child |
2,956 |
2,948 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,927 |
4,917 |
$97K |
| D1110 |
Prophylaxis - adult |
1,354 |
1,344 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,930 |
4,913 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,899 |
1,889 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
5,158 |
5,122 |
$62K |
| D0145 |
Oral evaluation for a patient under three years of age |
324 |
323 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,024 |
1,022 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
89 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
132 |
132 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
13 |
$2K |
| D0603 |
|
6,754 |
6,723 |
$9.00 |