| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
8,643 |
1,608 |
$166K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,467 |
1,432 |
$156K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,553 |
816 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
4,268 |
4,148 |
$98K |
| D1110 |
Prophylaxis - adult |
2,220 |
2,153 |
$90K |
| D1120 |
Prophylaxis - child |
2,996 |
2,941 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,252 |
535 |
$81K |
| D0274 |
Bitewings - four radiographic images |
3,138 |
3,036 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,896 |
5,077 |
$57K |
| D1206 |
Topical application of fluoride varnish |
4,814 |
4,731 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
960 |
501 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
5,476 |
5,319 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,229 |
1,179 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,019 |
1,005 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
583 |
527 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
24 |
$1K |
| D0603 |
|
3,958 |
3,907 |
$19.13 |
| D0601 |
|
1,245 |
1,230 |
$0.05 |
| D0602 |
|
1,467 |
1,418 |
$0.03 |