| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,171 |
1,026 |
$161K |
| D1120 |
Prophylaxis - child |
2,209 |
2,199 |
$93K |
| D4341 |
|
610 |
302 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
2,764 |
2,750 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,212 |
2,202 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,189 |
2,176 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,322 |
1,311 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
354 |
241 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,875 |
2,836 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,613 |
2,529 |
$18K |
| D1110 |
Prophylaxis - adult |
383 |
381 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
159 |
137 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
188 |
137 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
336 |
329 |
$6K |
| D0272 |
Bitewings - two radiographic images |
395 |
393 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
249 |
248 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
83 |
69 |
$3K |
| D1999 |
|
477 |
438 |
$0.00 |