| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,647 |
1,351 |
$158K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,112 |
482 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,100 |
3,039 |
$85K |
| D1120 |
Prophylaxis - child |
2,302 |
2,272 |
$81K |
| D1110 |
Prophylaxis - adult |
980 |
967 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,266 |
3,225 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,480 |
3,413 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,737 |
1,712 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,264 |
1,240 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,493 |
3,234 |
$36K |
| D0145 |
Oral evaluation for a patient under three years of age |
227 |
226 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
310 |
195 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
219 |
218 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
283 |
276 |
$9K |
| D0350 |
|
198 |
193 |
$2K |
| D0330 |
Panoramic radiographic image |
111 |
111 |
$2K |
| D0240 |
|
29 |
29 |
$284.20 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$262.92 |
| D0603 |
|
845 |
838 |
$18.01 |
| D0602 |
|
878 |
871 |
$18.01 |
| D0601 |
|
2,133 |
2,123 |
$0.00 |