| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
8,467 |
2,035 |
$210K |
| D0120 |
Periodic oral evaluation - established patient |
5,810 |
5,697 |
$158K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,200 |
1,096 |
$148K |
| D1120 |
Prophylaxis - child |
3,884 |
3,798 |
$134K |
| D1110 |
Prophylaxis - adult |
2,322 |
2,271 |
$120K |
| D0274 |
Bitewings - four radiographic images |
2,916 |
2,859 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,130 |
5,999 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
797 |
403 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
5,959 |
5,809 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,209 |
5,651 |
$66K |
| D0272 |
Bitewings - two radiographic images |
2,533 |
2,481 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
222 |
166 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
12 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
66 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
52 |
40 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$225.36 |
| D0602 |
|
3,814 |
3,719 |
$0.00 |
| D0603 |
|
2,968 |
2,889 |
$0.00 |
| D0601 |
|
253 |
233 |
$0.00 |
| D1999 |
|
1,046 |
986 |
$0.00 |