| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,308 |
1,741 |
$144K |
| D1120 |
Prophylaxis - child |
2,535 |
2,497 |
$143K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,018 |
2,001 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,152 |
3,032 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,862 |
2,816 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,097 |
3,048 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,631 |
1,614 |
$33K |
| D1354 |
|
2,389 |
725 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,123 |
1,095 |
$28K |
| D1110 |
Prophylaxis - adult |
249 |
246 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
235 |
131 |
$11K |
| D0274 |
Bitewings - four radiographic images |
176 |
176 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
15 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$212.85 |
| D0603 |
|
527 |
496 |
$0.00 |