| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,320 |
261 |
$32K |
| D1120 |
Prophylaxis - child |
823 |
784 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
285 |
130 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
739 |
708 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,283 |
1,219 |
$17K |
| D0272 |
Bitewings - two radiographic images |
769 |
744 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,397 |
930 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,190 |
1,111 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
267 |
241 |
$8K |
| D1110 |
Prophylaxis - adult |
117 |
100 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
74 |
67 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45 |
41 |
$1K |
| D0350 |
|
13 |
13 |
$177.04 |
| D0603 |
|
1,663 |
1,596 |
$0.00 |