| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
7,276 |
1,393 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
3,060 |
3,009 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
765 |
329 |
$68K |
| D1110 |
Prophylaxis - adult |
1,322 |
1,302 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,763 |
1,734 |
$55K |
| D1120 |
Prophylaxis - child |
1,519 |
1,494 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
2,922 |
2,869 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,164 |
2,643 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,569 |
1,546 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,401 |
1,381 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
108 |
106 |
$15K |
| D0272 |
Bitewings - two radiographic images |
216 |
208 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$423.84 |
| D0602 |
|
355 |
353 |
$0.00 |
| D0601 |
|
494 |
490 |
$0.00 |
| D0603 |
|
2,894 |
2,866 |
$0.00 |