| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,679 |
225 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
928 |
874 |
$19K |
| D1206 |
Topical application of fluoride varnish |
970 |
914 |
$16K |
| D1110 |
Prophylaxis - adult |
382 |
366 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,472 |
702 |
$13K |
| D1120 |
Prophylaxis - child |
406 |
388 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,029 |
944 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
49 |
$12K |
| D0274 |
Bitewings - four radiographic images |
239 |
226 |
$7K |
| D0330 |
Panoramic radiographic image |
88 |
85 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
71 |
$2K |
| D0272 |
Bitewings - two radiographic images |
109 |
101 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
65 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
13 |
$1K |
| D0602 |
|
14 |
14 |
$0.00 |