| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
11,261 |
5,065 |
$660K |
| D1120 |
Prophylaxis - child |
14,011 |
12,925 |
$563K |
| D0120 |
Periodic oral evaluation - established patient |
16,586 |
15,243 |
$454K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,953 |
12,876 |
$356K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,652 |
3,071 |
$300K |
| D4341 |
|
1,879 |
1,065 |
$276K |
| D0274 |
Bitewings - four radiographic images |
8,227 |
7,494 |
$144K |
| D1110 |
Prophylaxis - adult |
3,175 |
2,912 |
$135K |
| D2140 |
|
2,437 |
1,788 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,713 |
1,271 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,568 |
3,256 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
12,980 |
11,724 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,155 |
10,398 |
$55K |
| D2160 |
|
774 |
618 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
2,241 |
2,036 |
$35K |
| D0272 |
Bitewings - two radiographic images |
2,901 |
2,622 |
$28K |
| D4910 |
|
62 |
62 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
96 |
56 |
$4K |
| D2330 |
|
12 |
12 |
$584.74 |
| D1206 |
Topical application of fluoride varnish |
15 |
12 |
$338.00 |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
26 |
$328.17 |
| D1999 |
|
3,462 |
3,240 |
$14.45 |