| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,229 |
536 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
373 |
225 |
$18K |
| D1110 |
Prophylaxis - adult |
491 |
490 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
293 |
195 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
795 |
788 |
$11K |
| D0274 |
Bitewings - four radiographic images |
572 |
569 |
$10K |
| D1120 |
Prophylaxis - child |
487 |
482 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
975 |
969 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
981 |
958 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
975 |
922 |
$6K |
| D0272 |
Bitewings - two radiographic images |
352 |
349 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
44 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
169 |
168 |
$3K |
| D0330 |
Panoramic radiographic image |
228 |
228 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34 |
30 |
$406.80 |
| D0603 |
|
680 |
674 |
$0.00 |
| D0602 |
|
346 |
344 |
$0.00 |