| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,327 |
514 |
$116K |
| D1110 |
Prophylaxis - adult |
2,226 |
1,909 |
$107K |
| D0330 |
Panoramic radiographic image |
1,385 |
1,177 |
$75K |
| D1120 |
Prophylaxis - child |
1,984 |
1,658 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
794 |
504 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,431 |
2,882 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,653 |
2,232 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
476 |
320 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,578 |
1,233 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
588 |
356 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,298 |
1,115 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,370 |
1,172 |
$42K |
| D0272 |
Bitewings - two radiographic images |
571 |
495 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
698 |
521 |
$9K |
| D1320 |
|
127 |
114 |
$2K |
| D0180 |
|
72 |
62 |
$2K |
| D1330 |
|
24 |
20 |
$0.00 |
| D1310 |
|
25 |
21 |
$0.00 |