| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,075 |
500 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,797 |
757 |
$76K |
| D1120 |
Prophylaxis - child |
1,918 |
1,774 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,049 |
1,888 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
854 |
478 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,899 |
1,758 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,380 |
1,274 |
$27K |
| D2332 |
|
321 |
154 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,314 |
1,212 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
418 |
174 |
$20K |
| D1110 |
Prophylaxis - adult |
511 |
444 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
269 |
133 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,611 |
2,396 |
$14K |
| D0330 |
Panoramic radiographic image |
605 |
557 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,431 |
2,080 |
$9K |
| D0272 |
Bitewings - two radiographic images |
681 |
623 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
59 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
30 |
$150.80 |