| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,081 |
787 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
1,875 |
1,823 |
$52K |
| D1120 |
Prophylaxis - child |
1,457 |
1,417 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,228 |
1,176 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
392 |
237 |
$37K |
| D1110 |
Prophylaxis - adult |
710 |
686 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,448 |
2,376 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,240 |
2,161 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,186 |
2,070 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
694 |
651 |
$18K |
| D0272 |
Bitewings - two radiographic images |
689 |
672 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
109 |
70 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
198 |
181 |
$6K |
| D0330 |
Panoramic radiographic image |
200 |
200 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
45 |
$3K |
| D1330 |
|
12 |
12 |
$134.75 |
| D0602 |
|
1,055 |
1,027 |
$0.00 |
| D0603 |
|
1,366 |
1,345 |
$0.00 |