| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,699 |
553 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,093 |
1,981 |
$55K |
| D1120 |
Prophylaxis - child |
1,368 |
1,318 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,998 |
1,856 |
$40K |
| D1110 |
Prophylaxis - adult |
773 |
711 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,091 |
2,000 |
$29K |
| D0274 |
Bitewings - four radiographic images |
926 |
851 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,218 |
2,055 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
165 |
162 |
$23K |
| D0272 |
Bitewings - two radiographic images |
547 |
522 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
129 |
53 |
$11K |
| D0330 |
Panoramic radiographic image |
137 |
128 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
14 |
$1K |
| D1999 |
|
13 |
12 |
$0.00 |
| D0602 |
|
151 |
149 |
$0.00 |
| D0603 |
|
2,386 |
2,323 |
$0.00 |