| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,355 |
460 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,066 |
447 |
$70K |
| D1120 |
Prophylaxis - child |
1,633 |
1,631 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,188 |
2,183 |
$61K |
| D4341 |
|
420 |
171 |
$58K |
| D1110 |
Prophylaxis - adult |
1,014 |
1,013 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,507 |
1,505 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,890 |
1,885 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
551 |
397 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,120 |
1,118 |
$29K |
| D5120 |
|
64 |
64 |
$27K |
| D5110 |
|
50 |
50 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
469 |
315 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,868 |
2,855 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
170 |
84 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,546 |
2,541 |
$12K |
| D0330 |
Panoramic radiographic image |
555 |
551 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
480 |
475 |
$9K |
| D2332 |
|
47 |
25 |
$5K |
| D0272 |
Bitewings - two radiographic images |
385 |
385 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
29 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
133 |
132 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
73 |
73 |
$2K |