| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,477 |
356 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
535 |
191 |
$31K |
| D1110 |
Prophylaxis - adult |
805 |
778 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
496 |
473 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
757 |
744 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,708 |
1,656 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
523 |
510 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
288 |
126 |
$13K |
| D1120 |
Prophylaxis - child |
458 |
447 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,788 |
1,087 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,180 |
1,127 |
$7K |
| D0274 |
Bitewings - four radiographic images |
400 |
381 |
$5K |
| D0272 |
Bitewings - two radiographic images |
400 |
390 |
$5K |
| D0330 |
Panoramic radiographic image |
72 |
68 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
12 |
$994.53 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
26 |
$366.02 |
| D0603 |
|
1,363 |
1,321 |
$0.55 |
| D0601 |
|
90 |
81 |
$0.06 |
| D0602 |
|
98 |
96 |
$0.00 |