| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
20,783 |
2,745 |
$506K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,578 |
1,677 |
$330K |
| D1120 |
Prophylaxis - child |
6,491 |
5,471 |
$217K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,759 |
8,169 |
$176K |
| D1110 |
Prophylaxis - adult |
3,521 |
2,913 |
$157K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,071 |
3,428 |
$118K |
| D0330 |
Panoramic radiographic image |
2,400 |
1,993 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
5,830 |
4,883 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,285 |
723 |
$98K |
| D0274 |
Bitewings - four radiographic images |
2,849 |
2,358 |
$86K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
431 |
266 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
2,147 |
1,655 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,012 |
828 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
366 |
111 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,490 |
1,026 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
242 |
203 |
$8K |
| D0602 |
|
374 |
336 |
$6K |
| D0603 |
|
112 |
106 |
$2K |