| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
14,822 |
2,003 |
$323K |
| D1120 |
Prophylaxis - child |
4,915 |
4,807 |
$214K |
| D1206 |
Topical application of fluoride varnish |
6,152 |
5,965 |
$210K |
| D0210 |
Intraoral - complete series of radiographic images |
3,427 |
3,287 |
$184K |
| D0274 |
Bitewings - four radiographic images |
7,156 |
6,880 |
$159K |
| D0140 |
Limited oral evaluation - problem focused |
4,290 |
4,053 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,645 |
3,511 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
8,424 |
8,029 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
3,534 |
3,420 |
$80K |
| D1110 |
Prophylaxis - adult |
2,558 |
2,403 |
$79K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,253 |
1,252 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,751 |
6,973 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
544 |
229 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
510 |
294 |
$23K |
| D1353 |
|
1,484 |
241 |
$22K |
| D0160 |
|
530 |
482 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
269 |
162 |
$10K |
| D0603 |
|
1,616 |
1,597 |
$7K |
| D0999 |
Unspecified diagnostic procedure, by report |
216 |
216 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
149 |
92 |
$6K |
| D1999 |
|
156 |
156 |
$2K |
| D0330 |
Panoramic radiographic image |
69 |
67 |
$742.32 |
| D0601 |
|
1,320 |
1,100 |
$689.00 |
| D0602 |
|
37 |
28 |
$13.00 |