| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
5,444 |
876 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
918 |
315 |
$86K |
| D1120 |
Prophylaxis - child |
2,254 |
2,102 |
$74K |
| D0145 |
Oral evaluation for a patient under three years of age |
538 |
527 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,370 |
2,222 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,627 |
2,908 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,362 |
3,154 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,232 |
2,991 |
$36K |
| D1110 |
Prophylaxis - adult |
658 |
628 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,062 |
998 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,289 |
1,222 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
640 |
593 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
70 |
67 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
27 |
$507.06 |
| D0602 |
|
2,157 |
2,092 |
$0.00 |
| D0603 |
|
1,944 |
1,868 |
$0.00 |