| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,356 |
903 |
$119K |
| D0145 |
Oral evaluation for a patient under three years of age |
651 |
646 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
2,803 |
2,762 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,661 |
2,930 |
$72K |
| D1120 |
Prophylaxis - child |
1,999 |
1,972 |
$72K |
| D1110 |
Prophylaxis - adult |
1,053 |
1,048 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,439 |
1,429 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,082 |
3,048 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
428 |
219 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
543 |
270 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,079 |
3,027 |
$36K |
| D0350 |
|
1,581 |
1,547 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
231 |
231 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
317 |
300 |
$10K |
| D0240 |
|
717 |
715 |
$7K |
| D0272 |
Bitewings - two radiographic images |
304 |
296 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
85 |
76 |
$2K |
| D0330 |
Panoramic radiographic image |
52 |
52 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$300.48 |
| D0603 |
|
3,343 |
3,308 |
$27.25 |
| D0602 |
|
197 |
197 |
$0.00 |
| D0601 |
|
136 |
136 |
$0.00 |