| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
15,321 |
4,029 |
$428K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,851 |
2,840 |
$399K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,198 |
1,629 |
$320K |
| D1120 |
Prophylaxis - child |
7,409 |
7,388 |
$268K |
| D0120 |
Periodic oral evaluation - established patient |
8,474 |
8,437 |
$241K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,561 |
9,656 |
$220K |
| D1110 |
Prophylaxis - adult |
3,653 |
3,640 |
$197K |
| D0274 |
Bitewings - four radiographic images |
4,837 |
4,823 |
$165K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,137 |
11,094 |
$162K |
| D0220 |
Intraoral - periapical first radiographic image |
10,108 |
10,055 |
$125K |
| D0272 |
Bitewings - two radiographic images |
4,685 |
4,676 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,646 |
2,638 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
842 |
494 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
931 |
921 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
333 |
302 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
402 |
388 |
$7K |
| D7111 |
|
176 |
137 |
$2K |
| D0603 |
|
14,148 |
14,062 |
$0.00 |
| D9986 |
|
43 |
39 |
$0.00 |