| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
9,869 |
1,973 |
$435K |
| D1110 |
Prophylaxis - adult |
3,988 |
3,862 |
$263K |
| D0120 |
Periodic oral evaluation - established patient |
5,686 |
5,548 |
$222K |
| D1120 |
Prophylaxis - child |
3,181 |
3,105 |
$164K |
| D0274 |
Bitewings - four radiographic images |
3,061 |
2,992 |
$153K |
| D1206 |
Topical application of fluoride varnish |
3,844 |
3,730 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,422 |
2,351 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,351 |
1,293 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
191 |
122 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
434 |
421 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
36 |
$13K |
| D0272 |
Bitewings - two radiographic images |
340 |
328 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
428 |
411 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
385 |
363 |
$5K |
| D0601 |
|
3,834 |
3,705 |
$0.00 |
| D0602 |
|
1,872 |
1,826 |
$0.00 |
| D0603 |
|
717 |
689 |
$0.00 |