| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,298 |
739 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
757 |
318 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,674 |
2,512 |
$66K |
| D1110 |
Prophylaxis - adult |
1,397 |
1,303 |
$64K |
| D1120 |
Prophylaxis - child |
1,410 |
1,337 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,196 |
3,039 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,445 |
1,343 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
495 |
179 |
$35K |
| D0145 |
Oral evaluation for a patient under three years of age |
301 |
274 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
149 |
122 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
581 |
502 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
208 |
162 |
$4K |
| D0272 |
Bitewings - two radiographic images |
196 |
185 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
582 |
432 |
$4K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$123.58 |
| D0602 |
|
1,146 |
1,066 |
$0.06 |
| D0603 |
|
375 |
369 |
$0.02 |
| D0601 |
|
1,639 |
1,563 |
$0.02 |