| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,510 |
537 |
$82K |
| D1120 |
Prophylaxis - child |
2,077 |
2,047 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,517 |
2,481 |
$70K |
| D0145 |
Oral evaluation for a patient under three years of age |
237 |
235 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,965 |
1,202 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,492 |
1,471 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,587 |
1,519 |
$17K |
| D0272 |
Bitewings - two radiographic images |
781 |
755 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,045 |
1,027 |
$15K |
| D0330 |
Panoramic radiographic image |
126 |
125 |
$6K |
| D1110 |
Prophylaxis - adult |
87 |
85 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
12 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
97 |
89 |
$2K |
| D0274 |
Bitewings - four radiographic images |
46 |
44 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
37 |
31 |
$1K |
| D1330 |
|
62 |
61 |
$601.00 |
| D1999 |
|
355 |
341 |
$0.00 |
| D0603 |
|
3,474 |
3,439 |
$0.00 |