| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,552 |
771 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,561 |
3,491 |
$75K |
| D1110 |
Prophylaxis - adult |
1,802 |
1,762 |
$73K |
| D1206 |
Topical application of fluoride varnish |
3,852 |
3,767 |
$68K |
| D1120 |
Prophylaxis - child |
2,059 |
2,018 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
820 |
473 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,729 |
1,683 |
$49K |
| D0330 |
Panoramic radiographic image |
712 |
696 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
489 |
282 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,164 |
1,137 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,372 |
1,251 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
521 |
503 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
393 |
341 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
228 |
217 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
368 |
171 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
14 |
$912.75 |
| D0270 |
|
12 |
12 |
$168.00 |
| D1999 |
|
231 |
205 |
$0.00 |