| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,841 |
557 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
820 |
296 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,375 |
1,799 |
$54K |
| D1120 |
Prophylaxis - child |
1,018 |
952 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,134 |
1,977 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
872 |
840 |
$23K |
| D0274 |
Bitewings - four radiographic images |
768 |
715 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
738 |
664 |
$22K |
| D1110 |
Prophylaxis - adult |
419 |
398 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,518 |
1,425 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
263 |
143 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
121 |
111 |
$15K |
| D0272 |
Bitewings - two radiographic images |
122 |
111 |
$2K |
| D1206 |
Topical application of fluoride varnish |
82 |
82 |
$1K |
| D0602 |
|
467 |
456 |
$0.00 |
| D0601 |
|
955 |
855 |
$0.00 |
| D0603 |
|
671 |
637 |
$0.00 |