| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
9,099 |
1,648 |
$245K |
| D1110 |
Prophylaxis - adult |
5,312 |
5,092 |
$184K |
| D0274 |
Bitewings - four radiographic images |
4,573 |
4,388 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
5,065 |
4,849 |
$99K |
| D1120 |
Prophylaxis - child |
3,227 |
3,072 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,361 |
4,164 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,287 |
674 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,273 |
545 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
830 |
451 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,626 |
2,432 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,995 |
4,693 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
5,644 |
5,349 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
801 |
751 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,795 |
1,787 |
$32K |
| D0272 |
Bitewings - two radiographic images |
944 |
907 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
313 |
303 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
104 |
67 |
$6K |
| D2331 |
|
24 |
14 |
$1K |
| D2330 |
|
24 |
13 |
$1K |
| D1999 |
|
317 |
291 |
$0.00 |