| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,620 |
624 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,394 |
2,287 |
$64K |
| D1110 |
Prophylaxis - adult |
1,227 |
1,162 |
$60K |
| D1120 |
Prophylaxis - child |
1,511 |
1,424 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,015 |
2,862 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,294 |
2,944 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,424 |
1,313 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,251 |
3,019 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
252 |
108 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,103 |
1,039 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
144 |
136 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
350 |
304 |
$10K |
| D0330 |
Panoramic radiographic image |
791 |
710 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
45 |
$3K |
| D0603 |
|
3,061 |
2,878 |
$99.00 |
| D0601 |
|
266 |
249 |
$0.00 |