| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
10,851 |
1,328 |
$242K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,022 |
1,007 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
4,717 |
4,589 |
$128K |
| D1120 |
Prophylaxis - child |
3,258 |
3,160 |
$112K |
| D1110 |
Prophylaxis - adult |
1,881 |
1,820 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,859 |
4,711 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,206 |
2,129 |
$63K |
| D0272 |
Bitewings - two radiographic images |
2,317 |
2,229 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
474 |
267 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,313 |
1,208 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
310 |
150 |
$30K |
| D0330 |
Panoramic radiographic image |
1,359 |
1,266 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
393 |
382 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
315 |
271 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
32 |
13 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
514 |
479 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$434.79 |
| D1330 |
|
148 |
144 |
$124.75 |
| D0603 |
|
2,019 |
1,928 |
$0.00 |
| D0601 |
|
3,996 |
3,899 |
$0.00 |
| D0602 |
|
13 |
12 |
$0.00 |