| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
12,957 |
2,068 |
$246K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,087 |
2,037 |
$219K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,262 |
1,093 |
$160K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,996 |
7,442 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
6,527 |
6,361 |
$151K |
| D1120 |
Prophylaxis - child |
5,309 |
5,206 |
$145K |
| D0274 |
Bitewings - four radiographic images |
3,521 |
3,416 |
$90K |
| D1110 |
Prophylaxis - adult |
2,108 |
2,041 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,653 |
885 |
$86K |
| D1206 |
Topical application of fluoride varnish |
7,319 |
7,178 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
8,182 |
7,802 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,375 |
1,290 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,129 |
1,106 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
478 |
417 |
$8K |
| D0350 |
|
377 |
296 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
166 |
158 |
$2K |
| D0330 |
Panoramic radiographic image |
58 |
51 |
$1K |
| D4355 |
|
16 |
13 |
$220.30 |
| D1208 |
Topical application of fluoride, excluding varnish |
29 |
28 |
$191.10 |
| D0603 |
|
4,665 |
4,564 |
$18.12 |
| D0601 |
|
3,969 |
3,889 |
$12.02 |
| D0602 |
|
1,322 |
1,313 |
$9.01 |