| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
5,295 |
2,547 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
8,067 |
7,284 |
$207K |
| D1120 |
Prophylaxis - child |
5,209 |
4,916 |
$176K |
| D1206 |
Topical application of fluoride varnish |
5,169 |
4,873 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,349 |
1,254 |
$28K |
| D2332 |
|
330 |
148 |
$26K |
| D1110 |
Prophylaxis - adult |
582 |
540 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
332 |
195 |
$16K |
| D2335 |
|
138 |
52 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
495 |
444 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
619 |
494 |
$8K |
| D5120 |
|
12 |
12 |
$5K |
| D5110 |
|
12 |
12 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
868 |
805 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$524.45 |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$293.80 |
| D0602 |
|
1,778 |
1,701 |
$0.00 |
| D0601 |
|
3,284 |
3,086 |
$0.00 |
| D0603 |
|
190 |
190 |
$0.00 |