| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,063 |
601 |
$107K |
| D4341 |
|
659 |
318 |
$93K |
| D1120 |
Prophylaxis - child |
1,944 |
1,935 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
2,530 |
2,512 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,854 |
1,847 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,749 |
1,734 |
$34K |
| D1110 |
Prophylaxis - adult |
587 |
582 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
421 |
246 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
371 |
265 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
925 |
920 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
224 |
185 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,471 |
2,420 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,723 |
2,044 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
429 |
419 |
$8K |
| D0272 |
Bitewings - two radiographic images |
367 |
366 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
170 |
168 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
24 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
26 |
$1K |
| D1999 |
|
370 |
350 |
$0.00 |