| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,563 |
514 |
$114K |
| D1120 |
Prophylaxis - child |
3,035 |
2,922 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,472 |
3,330 |
$95K |
| D0145 |
Oral evaluation for a patient under three years of age |
658 |
636 |
$89K |
| D1110 |
Prophylaxis - adult |
1,142 |
1,106 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,194 |
4,022 |
$58K |
| D0272 |
Bitewings - two radiographic images |
2,575 |
2,482 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,277 |
3,131 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,191 |
2,925 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
361 |
149 |
$32K |
| D0330 |
Panoramic radiographic image |
581 |
542 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
623 |
594 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
136 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
120 |
58 |
$9K |
| D0274 |
Bitewings - four radiographic images |
253 |
246 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
83 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
50 |
43 |
$1K |
| D0603 |
|
1,048 |
1,011 |
$0.00 |
| D0601 |
|
2,781 |
2,665 |
$0.00 |
| D0602 |
|
1,011 |
965 |
$0.00 |
| D1330 |
|
40 |
40 |
$0.00 |