| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,829 |
732 |
$122K |
| D1110 |
Prophylaxis - adult |
3,037 |
2,840 |
$102K |
| D0274 |
Bitewings - four radiographic images |
3,022 |
2,812 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,777 |
2,606 |
$53K |
| D1120 |
Prophylaxis - child |
1,595 |
1,478 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
668 |
442 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,190 |
2,042 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,836 |
1,664 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,852 |
2,011 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,800 |
2,604 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
522 |
485 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
274 |
202 |
$13K |
| D1206 |
Topical application of fluoride varnish |
648 |
646 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
231 |
224 |
$9K |
| D0272 |
Bitewings - two radiographic images |
587 |
533 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
83 |
54 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
48 |
$5K |
| D0270 |
|
12 |
12 |
$94.24 |