| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,227 |
964 |
$165K |
| D1120 |
Prophylaxis - child |
3,746 |
3,642 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
3,895 |
3,786 |
$107K |
| D0145 |
Oral evaluation for a patient under three years of age |
764 |
751 |
$106K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,310 |
3,820 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
681 |
276 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
4,255 |
4,100 |
$50K |
| D1206 |
Topical application of fluoride varnish |
2,922 |
2,853 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,649 |
1,609 |
$37K |
| D1110 |
Prophylaxis - adult |
717 |
692 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
556 |
536 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,802 |
1,740 |
$25K |
| D0274 |
Bitewings - four radiographic images |
699 |
674 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
107 |
44 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
452 |
438 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
532 |
505 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
74 |
$1K |
| D0603 |
|
5,780 |
5,644 |
$0.00 |
| D0602 |
|
116 |
113 |
$0.00 |
| D0601 |
|
31 |
29 |
$0.00 |