| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,035 |
1,128 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
6,914 |
6,625 |
$188K |
| D1120 |
Prophylaxis - child |
4,513 |
4,407 |
$183K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,064 |
827 |
$159K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,259 |
753 |
$122K |
| D1110 |
Prophylaxis - adult |
2,534 |
2,439 |
$105K |
| D1206 |
Topical application of fluoride varnish |
4,079 |
4,001 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,933 |
2,870 |
$69K |
| D5110 |
|
146 |
145 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
2,292 |
2,222 |
$60K |
| D0330 |
Panoramic radiographic image |
2,565 |
2,500 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
6,909 |
6,576 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,811 |
1,745 |
$31K |
| D4341 |
|
210 |
131 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,602 |
5,981 |
$30K |
| D5120 |
|
64 |
64 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
347 |
322 |
$8K |
| D4342 |
|
47 |
27 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
52 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
228 |
222 |
$4K |
| D0272 |
Bitewings - two radiographic images |
222 |
199 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
14 |
$928.80 |
| D0601 |
|
376 |
375 |
$0.15 |
| D0603 |
|
94 |
94 |
$0.07 |
| D0602 |
|
116 |
116 |
$0.06 |
| D1999 |
|
446 |
388 |
$0.00 |