| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,227 |
324 |
$33K |
| D1120 |
Prophylaxis - child |
606 |
597 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
592 |
576 |
$16K |
| D1110 |
Prophylaxis - adult |
262 |
257 |
$14K |
| D0272 |
Bitewings - two radiographic images |
409 |
400 |
$9K |
| D0274 |
Bitewings - four radiographic images |
274 |
268 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
524 |
518 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
99 |
$7K |
| D1206 |
Topical application of fluoride varnish |
412 |
401 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
32 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
146 |
144 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
188 |
182 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
362 |
351 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
29 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
292 |
265 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
12 |
$3K |
| D0603 |
|
1,011 |
997 |
$0.00 |