| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,674 |
1,667 |
$173K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,666 |
718 |
$147K |
| D1120 |
Prophylaxis - child |
3,157 |
3,127 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,444 |
3,405 |
$112K |
| D0274 |
Bitewings - four radiographic images |
2,258 |
2,235 |
$75K |
| D1110 |
Prophylaxis - adult |
1,317 |
1,302 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,677 |
4,629 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
4,634 |
4,590 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,772 |
4,588 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,172 |
2,160 |
$49K |
| D0145 |
Oral evaluation for a patient under three years of age |
267 |
266 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,184 |
1,170 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
655 |
641 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
127 |
79 |
$10K |
| D0603 |
|
96 |
88 |
$0.00 |
| D0601 |
|
5,158 |
5,068 |
$0.00 |