| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,901 |
484 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
459 |
284 |
$24K |
| D1120 |
Prophylaxis - child |
1,280 |
1,263 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,472 |
1,458 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
533 |
341 |
$21K |
| D1110 |
Prophylaxis - adult |
606 |
598 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,879 |
1,855 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
204 |
200 |
$14K |
| D0274 |
Bitewings - four radiographic images |
704 |
697 |
$12K |
| D0272 |
Bitewings - two radiographic images |
897 |
885 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
429 |
419 |
$7K |
| D0330 |
Panoramic radiographic image |
360 |
353 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
689 |
678 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
627 |
606 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
146 |
124 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
38 |
$328.65 |
| D0603 |
|
1,933 |
1,913 |
$0.00 |
| D0601 |
|
152 |
148 |
$0.00 |