| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,838 |
314 |
$50K |
| D1120 |
Prophylaxis - child |
805 |
788 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
878 |
851 |
$24K |
| D1110 |
Prophylaxis - adult |
391 |
378 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,323 |
1,285 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,163 |
1,115 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
172 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,039 |
994 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
330 |
322 |
$11K |
| D0272 |
Bitewings - two radiographic images |
484 |
472 |
$11K |
| D0274 |
Bitewings - four radiographic images |
248 |
240 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
47 |
45 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
15 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$225.36 |
| D0602 |
|
1,454 |
1,410 |
$0.00 |
| D0603 |
|
81 |
80 |
$0.00 |