| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,934 |
324 |
$51K |
| D1120 |
Prophylaxis - child |
885 |
859 |
$31K |
| D0330 |
Panoramic radiographic image |
540 |
517 |
$30K |
| D1110 |
Prophylaxis - adult |
613 |
591 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,100 |
1,063 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,389 |
1,339 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,075 |
1,038 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
594 |
546 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
191 |
167 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
199 |
183 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
36 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
27 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
26 |
$3K |
| D1206 |
Topical application of fluoride varnish |
126 |
122 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
203 |
96 |
$2K |
| D1999 |
|
317 |
267 |
$0.00 |