| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,766 |
1,796 |
$266K |
| D1120 |
Prophylaxis - child |
4,652 |
4,535 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
6,245 |
6,085 |
$175K |
| D4341 |
|
911 |
437 |
$137K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,555 |
4,438 |
$119K |
| D1110 |
Prophylaxis - adult |
1,439 |
1,413 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,024 |
775 |
$64K |
| D0274 |
Bitewings - four radiographic images |
3,366 |
3,273 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
5,395 |
5,212 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,411 |
1,380 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
490 |
311 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,336 |
4,536 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
561 |
446 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
619 |
598 |
$11K |
| D0272 |
Bitewings - two radiographic images |
765 |
739 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
41 |
$4K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
12 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
120 |
117 |
$3K |
| D4910 |
|
24 |
24 |
$2K |
| D0270 |
|
268 |
262 |
$1K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$286.00 |
| D1999 |
|
108 |
108 |
$0.00 |