| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,317 |
689 |
$107K |
| D0145 |
Oral evaluation for a patient under three years of age |
717 |
697 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
1,900 |
1,854 |
$52K |
| D1120 |
Prophylaxis - child |
1,419 |
1,376 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,357 |
2,292 |
$33K |
| D1110 |
Prophylaxis - adult |
545 |
528 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,031 |
1,905 |
$23K |
| D0274 |
Bitewings - four radiographic images |
800 |
768 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,976 |
1,742 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
166 |
77 |
$16K |
| D0272 |
Bitewings - two radiographic images |
644 |
628 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
164 |
155 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
158 |
139 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$2K |
| D0330 |
Panoramic radiographic image |
73 |
71 |
$2K |
| D0602 |
|
3,615 |
3,540 |
$0.40 |