| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,738 |
810 |
$129K |
| D0145 |
Oral evaluation for a patient under three years of age |
428 |
426 |
$58K |
| D1110 |
Prophylaxis - adult |
1,072 |
1,060 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,667 |
1,643 |
$46K |
| D1120 |
Prophylaxis - child |
1,118 |
1,101 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,530 |
1,505 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,260 |
2,226 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,175 |
1,199 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
523 |
513 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
160 |
63 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,559 |
1,447 |
$13K |
| D0330 |
Panoramic radiographic image |
209 |
204 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
38 |
$2K |
| D0602 |
|
898 |
887 |
$0.00 |
| D0603 |
|
1,412 |
1,390 |
$0.00 |
| D0601 |
|
421 |
414 |
$0.00 |