| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,248 |
664 |
$98K |
| D1120 |
Prophylaxis - child |
875 |
837 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,431 |
1,270 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,129 |
1,080 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,212 |
924 |
$21K |
| D1110 |
Prophylaxis - adult |
484 |
460 |
$17K |
| D0274 |
Bitewings - four radiographic images |
720 |
690 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
244 |
110 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
182 |
75 |
$15K |
| D0330 |
Panoramic radiographic image |
394 |
373 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,094 |
1,031 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
172 |
90 |
$11K |
| D0272 |
Bitewings - two radiographic images |
545 |
526 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
257 |
243 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
128 |
121 |
$3K |