| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,449 |
1,434 |
$168K |
| D1120 |
Prophylaxis - child |
3,767 |
3,685 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
4,483 |
4,389 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,879 |
4,769 |
$85K |
| D1110 |
Prophylaxis - adult |
1,150 |
1,126 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,429 |
1,346 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,589 |
1,553 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
363 |
235 |
$28K |
| D0330 |
Panoramic radiographic image |
465 |
455 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
215 |
116 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
216 |
209 |
$8K |
| D0274 |
Bitewings - four radiographic images |
214 |
211 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
176 |
169 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
12 |
$221.00 |
| D1999 |
|
1,654 |
1,497 |
$0.00 |