| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
131,254 |
21,850 |
$1.99M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,441 |
6,286 |
$1.21M |
| D0120 |
Periodic oral evaluation - established patient |
58,508 |
51,122 |
$1.13M |
| D1120 |
Prophylaxis - child |
32,839 |
29,245 |
$829K |
| D0274 |
Bitewings - four radiographic images |
44,015 |
37,328 |
$824K |
| D0230 |
Intraoral - periapical each additional radiographic image |
99,105 |
46,996 |
$756K |
| D1110 |
Prophylaxis - adult |
19,478 |
17,352 |
$699K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,988 |
5,331 |
$545K |
| D0220 |
Intraoral - periapical first radiographic image |
55,050 |
48,430 |
$480K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19,771 |
16,890 |
$390K |
| D1206 |
Topical application of fluoride varnish |
39,216 |
34,405 |
$370K |
| D0210 |
Intraoral - complete series of radiographic images |
7,976 |
6,856 |
$334K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,132 |
2,805 |
$329K |
| D1208 |
Topical application of fluoride, excluding varnish |
28,450 |
25,967 |
$305K |
| D0272 |
Bitewings - two radiographic images |
10,322 |
9,361 |
$178K |
| D0330 |
Panoramic radiographic image |
2,539 |
2,189 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
286 |
118 |
$24K |
| D0340 |
|
76 |
76 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
39 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
202 |
156 |
$2K |
| D2332 |
|
37 |
13 |
$1K |
| D0603 |
|
43,365 |
39,554 |
$983.58 |
| D1330 |
|
574 |
476 |
$416.78 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
13 |
$271.99 |
| D0602 |
|
17,118 |
15,671 |
$132.37 |
| D4346 |
|
74 |
59 |
$55.00 |
| D0601 |
|
18,906 |
16,954 |
$36.11 |