| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,736 |
263 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,131 |
1,065 |
$30K |
| D1120 |
Prophylaxis - child |
819 |
760 |
$27K |
| D1110 |
Prophylaxis - adult |
512 |
471 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
246 |
128 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
319 |
148 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
166 |
144 |
$18K |
| D0274 |
Bitewings - four radiographic images |
583 |
538 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,320 |
1,224 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,537 |
744 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
889 |
810 |
$10K |
| D0272 |
Bitewings - two radiographic images |
432 |
399 |
$8K |
| D0330 |
Panoramic radiographic image |
131 |
126 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
164 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
58 |
$863.88 |
| D0350 |
|
55 |
48 |
$808.72 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$706.40 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18 |
16 |
$406.65 |
| D1206 |
Topical application of fluoride varnish |
16 |
14 |
$161.70 |
| D0603 |
|
59 |
52 |
$0.00 |
| D0601 |
|
556 |
511 |
$0.00 |
| D0602 |
|
785 |
745 |
$0.00 |