| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
11,746 |
2,442 |
$295K |
| D0120 |
Periodic oral evaluation - established patient |
5,627 |
5,439 |
$152K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,109 |
1,090 |
$150K |
| D1120 |
Prophylaxis - child |
3,928 |
3,800 |
$134K |
| D1110 |
Prophylaxis - adult |
2,164 |
2,082 |
$109K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,081 |
5,877 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
891 |
505 |
$81K |
| D0272 |
Bitewings - two radiographic images |
3,381 |
3,263 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
5,642 |
5,415 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,960 |
1,887 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,478 |
5,193 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
662 |
649 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
349 |
201 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
233 |
224 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
50 |
27 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
155 |
141 |
$4K |
| D1330 |
|
394 |
379 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
69 |
$1K |
| D0330 |
Panoramic radiographic image |
60 |
58 |
$709.88 |
| D0603 |
|
1,177 |
1,138 |
$0.00 |
| D0602 |
|
3,079 |
3,000 |
$0.00 |
| D0601 |
|
2,890 |
2,796 |
$0.00 |