| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
20,280 |
1,757 |
$120K |
| D0140 |
Limited oral evaluation - problem focused |
11,799 |
5,777 |
$102K |
| D0330 |
Panoramic radiographic image |
5,966 |
3,457 |
$95K |
| D1120 |
Prophylaxis - child |
8,903 |
4,669 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
14,762 |
7,070 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,802 |
2,947 |
$35K |
| D0272 |
Bitewings - two radiographic images |
8,435 |
4,406 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,000 |
4,762 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,115 |
5,266 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
838 |
270 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
737 |
698 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
28 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
505 |
124 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
44 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
691 |
205 |
$0.00 |