| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
20,862 |
3,436 |
$761K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,257 |
2,517 |
$517K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,928 |
1,246 |
$271K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,581 |
1,258 |
$267K |
| D1110 |
Prophylaxis - adult |
5,376 |
5,212 |
$255K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,475 |
4,412 |
$190K |
| D0140 |
Limited oral evaluation - problem focused |
3,636 |
3,377 |
$185K |
| D0274 |
Bitewings - four radiographic images |
4,542 |
4,394 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
5,294 |
5,224 |
$161K |
| D1120 |
Prophylaxis - child |
3,432 |
3,388 |
$148K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,434 |
5,302 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,668 |
1,100 |
$131K |
| D0330 |
Panoramic radiographic image |
1,419 |
1,397 |
$117K |
| D0210 |
Intraoral - complete series of radiographic images |
1,645 |
1,636 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
4,078 |
3,847 |
$78K |
| D0272 |
Bitewings - two radiographic images |
1,952 |
1,921 |
$61K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
342 |
149 |
$60K |
| D1206 |
Topical application of fluoride varnish |
2,961 |
2,895 |
$58K |
| D2332 |
|
565 |
359 |
$52K |
| D2791 |
|
356 |
258 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,465 |
1,036 |
$26K |
| D4346 |
|
211 |
205 |
$22K |
| D2335 |
|
208 |
119 |
$22K |
| D2394 |
|
66 |
49 |
$11K |
| D2330 |
|
222 |
161 |
$10K |
| D2331 |
|
88 |
63 |
$5K |
| D9110 |
|
53 |
50 |
$4K |
| D4355 |
|
49 |
48 |
$4K |
| D0170 |
|
13 |
13 |
$237.23 |