| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
30,145 |
29,676 |
$481K |
| D0191 |
|
24,931 |
24,590 |
$343K |
| D1351 |
Sealant - per tooth |
15,903 |
3,793 |
$340K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,722 |
1,298 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
1,449 |
1,408 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,642 |
887 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,803 |
2,742 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,295 |
902 |
$63K |
| D1110 |
Prophylaxis - adult |
1,993 |
1,935 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
2,385 |
2,261 |
$49K |
| D1120 |
Prophylaxis - child |
1,358 |
1,314 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,569 |
1,528 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,348 |
1,336 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,242 |
2,143 |
$19K |
| D1354 |
|
1,482 |
391 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
158 |
131 |
$11K |
| D0272 |
Bitewings - two radiographic images |
446 |
428 |
$6K |
| D2330 |
|
129 |
82 |
$6K |
| D2331 |
|
59 |
50 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
508 |
328 |
$3K |
| D0330 |
Panoramic radiographic image |
47 |
44 |
$2K |
| D0240 |
|
107 |
56 |
$1K |
| D2394 |
|
15 |
13 |
$1K |
| D0270 |
|
84 |
83 |
$830.43 |