| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
9,160 |
7,088 |
$324K |
| D1120 |
Prophylaxis - child |
6,424 |
5,583 |
$170K |
| D1351 |
Sealant - per tooth |
6,481 |
937 |
$167K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,280 |
6,236 |
$142K |
| D1206 |
Topical application of fluoride varnish |
6,099 |
5,341 |
$135K |
| D0330 |
Panoramic radiographic image |
4,240 |
3,618 |
$130K |
| D0210 |
Intraoral - complete series of radiographic images |
1,440 |
1,017 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
7,155 |
6,217 |
$61K |
| D0272 |
Bitewings - two radiographic images |
3,486 |
3,021 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
461 |
363 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
285 |
164 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
960 |
861 |
$32K |
| D4341 |
|
261 |
64 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
28 |
$4K |