| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
203,227 |
46,753 |
$5.99M |
| D1120 |
Prophylaxis - child |
121,863 |
121,794 |
$4.93M |
| D1206 |
Topical application of fluoride varnish |
125,431 |
125,352 |
$3.20M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24,616 |
13,290 |
$3.14M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26,475 |
14,364 |
$2.59M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54,438 |
54,416 |
$2.40M |
| D0120 |
Periodic oral evaluation - established patient |
74,702 |
74,654 |
$2.09M |
| D1354 |
|
85,837 |
27,095 |
$2.05M |
| D0272 |
Bitewings - two radiographic images |
51,084 |
51,057 |
$1.18M |
| D0220 |
Intraoral - periapical first radiographic image |
44,564 |
44,479 |
$759K |
| D0274 |
Bitewings - four radiographic images |
18,369 |
18,355 |
$635K |
| D0230 |
Intraoral - periapical each additional radiographic image |
44,896 |
42,083 |
$419K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,527 |
2,121 |
$394K |
| D1110 |
Prophylaxis - adult |
6,078 |
6,062 |
$304K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,719 |
1,768 |
$237K |
| D2330 |
|
1,621 |
1,160 |
$136K |
| D2331 |
|
280 |
219 |
$28K |
| D2394 |
|
105 |
90 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
251 |
245 |
$17K |
| D0270 |
|
1,147 |
1,146 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
278 |
278 |
$8K |
| D7111 |
|
110 |
85 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
73 |
43 |
$6K |
| D0273 |
|
186 |
186 |
$5K |
| D2332 |
|
41 |
24 |
$5K |
| D2160 |
|
36 |
24 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
77 |
77 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
14 |
$2K |
| D1352 |
|
21 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$1K |
| D0160 |
|
18 |
18 |
$0.00 |
| D3120 |
|
48 |
41 |
$0.00 |