| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,785 |
269 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
215 |
210 |
$26K |
| D1120 |
Prophylaxis - child |
718 |
708 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
394 |
384 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
915 |
899 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
457 |
438 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,349 |
797 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,002 |
946 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
138 |
70 |
$9K |
| D0272 |
Bitewings - two radiographic images |
526 |
509 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
308 |
290 |
$7K |
| D1110 |
Prophylaxis - adult |
141 |
136 |
$6K |
| D0330 |
Panoramic radiographic image |
145 |
141 |
$4K |
| D0274 |
Bitewings - four radiographic images |
139 |
133 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
70 |
68 |
$1K |
| D0601 |
|
13 |
13 |
$0.00 |
| D0603 |
|
1,044 |
1,011 |
$0.00 |
| D0602 |
|
128 |
124 |
$0.00 |