| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
11,413 |
2,130 |
$308K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,251 |
1,238 |
$172K |
| D0120 |
Periodic oral evaluation - established patient |
4,819 |
4,757 |
$135K |
| D1120 |
Prophylaxis - child |
3,238 |
3,207 |
$116K |
| D1110 |
Prophylaxis - adult |
1,961 |
1,943 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,410 |
4,382 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,155 |
5,104 |
$74K |
| D0274 |
Bitewings - four radiographic images |
2,021 |
2,001 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
4,623 |
4,539 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,452 |
2,426 |
$55K |
| D0330 |
Panoramic radiographic image |
776 |
772 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
458 |
298 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
272 |
189 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
658 |
654 |
$22K |
| D1206 |
Topical application of fluoride varnish |
147 |
147 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$777.49 |
| D0603 |
|
4,225 |
4,173 |
$0.32 |
| D0602 |
|
1,073 |
1,066 |
$0.01 |
| D9986 |
|
15 |
15 |
$0.00 |
| D0601 |
|
1,553 |
1,534 |
$0.00 |