| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
10,799 |
1,391 |
$254K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,987 |
694 |
$153K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,376 |
527 |
$98K |
| D1110 |
Prophylaxis - adult |
1,954 |
1,829 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
2,812 |
2,631 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,491 |
1,392 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,634 |
3,180 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,543 |
2,374 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,818 |
2,715 |
$38K |
| D1120 |
Prophylaxis - child |
1,255 |
1,165 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
149 |
68 |
$13K |
| D0272 |
Bitewings - two radiographic images |
505 |
469 |
$10K |
| D0330 |
Panoramic radiographic image |
165 |
149 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
268 |
245 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
188 |
169 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
67 |
56 |
$2K |
| D0240 |
|
34 |
31 |
$515.16 |