| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
12,345 |
2,549 |
$329K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,718 |
1,588 |
$258K |
| D0120 |
Periodic oral evaluation - established patient |
8,468 |
8,342 |
$233K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,591 |
1,576 |
$220K |
| D1120 |
Prophylaxis - child |
6,196 |
6,105 |
$215K |
| D1110 |
Prophylaxis - adult |
3,138 |
3,091 |
$161K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,363 |
5,695 |
$144K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,156 |
9,018 |
$128K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
896 |
275 |
$124K |
| D9248 |
|
1,016 |
948 |
$120K |
| D0210 |
Intraoral - complete series of radiographic images |
1,584 |
1,564 |
$100K |
| D0274 |
Bitewings - four radiographic images |
3,009 |
2,964 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,149 |
788 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
6,674 |
6,480 |
$78K |
| D0272 |
Bitewings - two radiographic images |
2,545 |
2,514 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
767 |
750 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
607 |
567 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
550 |
529 |
$9K |
| D0603 |
|
10,927 |
10,805 |
$0.00 |
| D0602 |
|
22 |
22 |
$0.00 |