| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
7,612 |
1,754 |
$121K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,606 |
1,007 |
$111K |
| D1110 |
Prophylaxis - adult |
2,486 |
2,407 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,407 |
861 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
3,676 |
3,558 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,641 |
2,565 |
$55K |
| D1120 |
Prophylaxis - child |
2,363 |
2,329 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,175 |
4,105 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,330 |
1,310 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,635 |
3,543 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,986 |
1,959 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,547 |
3,247 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
285 |
282 |
$22K |
| D0330 |
Panoramic radiographic image |
1,314 |
1,294 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
205 |
205 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
140 |
106 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
499 |
428 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
46 |
12 |
$7K |
| D1206 |
Topical application of fluoride varnish |
302 |
302 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
69 |
$1K |
| D0603 |
|
4,527 |
4,438 |
$0.00 |
| D0602 |
|
665 |
645 |
$0.00 |
| D0601 |
|
37 |
37 |
$0.00 |
| D1999 |
|
189 |
154 |
$0.00 |