| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,360 |
206 |
$32K |
| D1120 |
Prophylaxis - child |
853 |
813 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
534 |
508 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,087 |
1,018 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,150 |
966 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
115 |
45 |
$10K |
| D1206 |
Topical application of fluoride varnish |
791 |
758 |
$10K |
| D0274 |
Bitewings - four radiographic images |
328 |
307 |
$10K |
| D0272 |
Bitewings - two radiographic images |
428 |
415 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
276 |
261 |
$9K |
| D1110 |
Prophylaxis - adult |
105 |
99 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
18 |
15 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
162 |
154 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
52 |
45 |
$1K |
| D0603 |
|
1,399 |
1,294 |
$0.00 |