| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,285 |
561 |
$84K |
| D4341 |
|
407 |
229 |
$62K |
| D1120 |
Prophylaxis - child |
1,453 |
1,453 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,886 |
1,883 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,432 |
1,432 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
529 |
404 |
$33K |
| D2332 |
|
293 |
200 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
486 |
334 |
$31K |
| D1110 |
Prophylaxis - adult |
655 |
655 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
303 |
226 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,417 |
1,414 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,006 |
1,006 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
534 |
365 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,202 |
1,165 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
3,112 |
3,071 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,289 |
2,274 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
156 |
116 |
$15K |
| D5110 |
|
33 |
33 |
$15K |
| D5120 |
|
30 |
30 |
$13K |
| D2335 |
|
93 |
72 |
$10K |
| D2940 |
|
628 |
499 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
326 |
326 |
$8K |
| D2330 |
|
106 |
62 |
$6K |
| D0272 |
Bitewings - two radiographic images |
352 |
352 |
$4K |
| D0270 |
|
336 |
335 |
$2K |