| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
5,024 |
1,175 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
4,059 |
4,014 |
$114K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,172 |
626 |
$112K |
| D1120 |
Prophylaxis - child |
2,948 |
2,904 |
$104K |
| D0145 |
Oral evaluation for a patient under three years of age |
622 |
614 |
$86K |
| D1110 |
Prophylaxis - adult |
1,369 |
1,358 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,614 |
4,554 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,958 |
4,585 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
4,857 |
4,747 |
$58K |
| D0272 |
Bitewings - two radiographic images |
2,438 |
2,397 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,425 |
1,409 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
494 |
342 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
103 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
38 |
$1K |
| D1330 |
|
99 |
94 |
$1K |
| D0603 |
|
3,926 |
3,881 |
$0.00 |
| D0602 |
|
553 |
538 |
$0.00 |
| D0601 |
|
504 |
501 |
$0.00 |