| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,757 |
521 |
$130K |
| D0140 |
Limited oral evaluation - problem focused |
1,495 |
1,142 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
578 |
279 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
478 |
322 |
$55K |
| D4341 |
|
507 |
279 |
$44K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
214 |
168 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
771 |
770 |
$31K |
| D1120 |
Prophylaxis - child |
584 |
582 |
$26K |
| D4355 |
|
325 |
324 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,042 |
992 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
764 |
763 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
242 |
179 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
529 |
528 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
954 |
543 |
$14K |
| D1110 |
Prophylaxis - adult |
287 |
285 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
284 |
283 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
115 |
105 |
$13K |
| D9110 |
|
171 |
158 |
$12K |
| D0274 |
Bitewings - four radiographic images |
531 |
529 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
233 |
205 |
$10K |
| D0272 |
Bitewings - two radiographic images |
177 |
176 |
$4K |
| D2335 |
|
36 |
24 |
$3K |
| D2332 |
|
18 |
14 |
$1K |
| D0270 |
|
40 |
39 |
$476.72 |