| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,622 |
423 |
$39K |
| D0145 |
Oral evaluation for a patient under three years of age |
291 |
268 |
$37K |
| D1120 |
Prophylaxis - child |
1,095 |
972 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
352 |
221 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
976 |
861 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
146 |
69 |
$19K |
| D0272 |
Bitewings - two radiographic images |
929 |
811 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,314 |
1,171 |
$17K |
| D9248 |
|
145 |
125 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
162 |
112 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,106 |
965 |
$12K |
| D1110 |
Prophylaxis - adult |
216 |
197 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
956 |
820 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
463 |
410 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
216 |
188 |
$6K |
| D0330 |
Panoramic radiographic image |
151 |
123 |
$5K |
| D0274 |
Bitewings - four radiographic images |
138 |
120 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$450.72 |
| D0270 |
|
35 |
26 |
$117.60 |
| D0191 |
|
29 |
28 |
$0.00 |
| D0603 |
|
1,455 |
1,320 |
$0.00 |