| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
8,114 |
1,493 |
$266K |
| D1110 |
Prophylaxis - adult |
5,507 |
5,357 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
7,587 |
7,379 |
$146K |
| D0274 |
Bitewings - four radiographic images |
5,369 |
5,199 |
$124K |
| D1120 |
Prophylaxis - child |
3,590 |
3,498 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,277 |
3,212 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,208 |
529 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,042 |
2,920 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
6,739 |
6,484 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
1,314 |
1,292 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,073 |
5,504 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
776 |
489 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
972 |
930 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,998 |
1,995 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,637 |
1,596 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
191 |
63 |
$12K |
| D4341 |
|
20 |
14 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
26 |
$2K |
| D2330 |
|
27 |
13 |
$1K |