| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
8,318 |
3,136 |
$469K |
| D1120 |
Prophylaxis - child |
8,728 |
8,422 |
$356K |
| D0120 |
Periodic oral evaluation - established patient |
8,703 |
8,175 |
$238K |
| D1110 |
Prophylaxis - adult |
5,390 |
5,130 |
$232K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,153 |
1,073 |
$230K |
| D5110 |
|
529 |
524 |
$211K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,173 |
7,814 |
$184K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,300 |
6,074 |
$163K |
| D5120 |
|
402 |
395 |
$161K |
| D0274 |
Bitewings - four radiographic images |
7,200 |
6,881 |
$129K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,179 |
11,935 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,651 |
1,003 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
14,123 |
13,319 |
$82K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
744 |
246 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,033 |
569 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
499 |
351 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,527 |
1,478 |
$26K |
| D2332 |
|
337 |
176 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
858 |
815 |
$9K |
| D0272 |
Bitewings - two radiographic images |
829 |
787 |
$8K |
| D0270 |
|
15 |
14 |
$84.00 |