| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,469 |
780 |
$119K |
| D1110 |
Prophylaxis - adult |
3,533 |
3,435 |
$113K |
| D0274 |
Bitewings - four radiographic images |
3,455 |
3,353 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
4,246 |
4,115 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
949 |
495 |
$54K |
| D1120 |
Prophylaxis - child |
1,901 |
1,854 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,432 |
4,044 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
5,059 |
4,878 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,984 |
1,935 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,541 |
1,487 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
890 |
866 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
609 |
588 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,033 |
1,021 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
299 |
189 |
$14K |
| D0272 |
Bitewings - two radiographic images |
842 |
816 |
$12K |
| D0270 |
|
459 |
443 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
31 |
$3K |
| D2331 |
|
25 |
13 |
$997.76 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$908.60 |
| D1999 |
|
26 |
26 |
$0.00 |