| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,151 |
543 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
446 |
170 |
$42K |
| D1120 |
Prophylaxis - child |
1,139 |
1,096 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,410 |
1,344 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,978 |
1,462 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
231 |
212 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,583 |
1,514 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,602 |
1,512 |
$18K |
| D0274 |
Bitewings - four radiographic images |
517 |
482 |
$16K |
| D1110 |
Prophylaxis - adult |
168 |
154 |
$8K |
| D0272 |
Bitewings - two radiographic images |
189 |
187 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
38 |
$1K |
| D0603 |
|
874 |
814 |
$0.00 |
| D0602 |
|
1,191 |
1,135 |
$0.00 |