| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
9,660 |
1,794 |
$264K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,497 |
1,474 |
$206K |
| D1120 |
Prophylaxis - child |
4,179 |
4,116 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
5,049 |
4,992 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,223 |
687 |
$116K |
| D1110 |
Prophylaxis - adult |
1,768 |
1,748 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,765 |
5,683 |
$83K |
| D0272 |
Bitewings - two radiographic images |
3,661 |
3,610 |
$78K |
| D0274 |
Bitewings - four radiographic images |
1,887 |
1,867 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
3,981 |
3,921 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,798 |
3,708 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,503 |
1,335 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
865 |
837 |
$28K |
| D0330 |
Panoramic radiographic image |
904 |
894 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
197 |
130 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
190 |
189 |
$13K |
| D0602 |
|
3,115 |
3,081 |
$0.00 |
| D0603 |
|
4,164 |
4,124 |
$0.00 |
| D0601 |
|
78 |
77 |
$0.00 |