| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,856 |
1,767 |
$189K |
| D1120 |
Prophylaxis - child |
3,909 |
3,891 |
$140K |
| D0145 |
Oral evaluation for a patient under three years of age |
967 |
965 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
3,673 |
3,659 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,177 |
2,698 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,277 |
4,260 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
624 |
351 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
3,074 |
3,011 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,366 |
1,282 |
$28K |
| D0330 |
Panoramic radiographic image |
419 |
416 |
$26K |
| D0272 |
Bitewings - two radiographic images |
808 |
804 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
539 |
538 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
187 |
141 |
$14K |
| D0274 |
Bitewings - four radiographic images |
357 |
357 |
$12K |
| D1110 |
Prophylaxis - adult |
155 |
155 |
$8K |
| D9248 |
|
40 |
38 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
39 |
$694.86 |
| D0603 |
|
5,378 |
5,317 |
$0.00 |
| D0601 |
|
162 |
160 |
$0.00 |
| D0602 |
|
71 |
69 |
$0.00 |