| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,509 |
507 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,792 |
1,761 |
$47K |
| D1110 |
Prophylaxis - adult |
877 |
862 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
335 |
186 |
$32K |
| D0274 |
Bitewings - four radiographic images |
993 |
976 |
$32K |
| D1120 |
Prophylaxis - child |
809 |
802 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
341 |
196 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,720 |
1,698 |
$24K |
| D0272 |
Bitewings - two radiographic images |
413 |
408 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$543.52 |
| D0603 |
|
2,939 |
2,522 |
$0.00 |