| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,109 |
487 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
1,396 |
1,336 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
376 |
233 |
$36K |
| D1110 |
Prophylaxis - adult |
719 |
686 |
$35K |
| D0274 |
Bitewings - four radiographic images |
762 |
734 |
$25K |
| D1120 |
Prophylaxis - child |
655 |
639 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,585 |
1,523 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,501 |
1,432 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,433 |
1,360 |
$15K |
| D0272 |
Bitewings - two radiographic images |
322 |
296 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$384.99 |
| D0602 |
|
1,592 |
1,553 |
$36.00 |
| D1999 |
|
1,035 |
953 |
$0.00 |