| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
49,694 |
12,109 |
$1.36M |
| D1120 |
Prophylaxis - child |
24,046 |
23,838 |
$779K |
| D1206 |
Topical application of fluoride varnish |
28,625 |
28,393 |
$578K |
| D0120 |
Periodic oral evaluation - established patient |
16,441 |
16,333 |
$361K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,784 |
13,646 |
$317K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,833 |
2,200 |
$257K |
| D0272 |
Bitewings - two radiographic images |
13,863 |
13,703 |
$236K |
| D0274 |
Bitewings - four radiographic images |
7,559 |
7,517 |
$223K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,628 |
2,244 |
$203K |
| D1330 |
|
17,712 |
17,646 |
$172K |
| D1310 |
|
17,728 |
17,662 |
$164K |
| D1110 |
Prophylaxis - adult |
4,008 |
3,985 |
$156K |
| D1354 |
|
4,908 |
3,115 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,485 |
12,118 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
12,741 |
12,597 |
$114K |
| D7140 |
Extraction, erupted tooth or exposed root |
448 |
296 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
66 |
$6K |
| D2331 |
|
94 |
67 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
105 |
105 |
$5K |
| D2330 |
|
82 |
60 |
$4K |
| D0273 |
|
29 |
29 |
$692.36 |