| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
55,774 |
14,244 |
$1.88M |
| D1120 |
Prophylaxis - child |
33,061 |
32,429 |
$1.43M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17,619 |
17,358 |
$913K |
| D1206 |
Topical application of fluoride varnish |
27,297 |
26,841 |
$669K |
| D0120 |
Periodic oral evaluation - established patient |
17,742 |
17,348 |
$518K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,049 |
1,702 |
$357K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,757 |
1,986 |
$342K |
| D0272 |
Bitewings - two radiographic images |
22,516 |
22,070 |
$338K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,706 |
7,499 |
$174K |
| D1330 |
|
21,808 |
21,476 |
$133K |
| D0274 |
Bitewings - four radiographic images |
2,200 |
2,162 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
4,549 |
4,471 |
$40K |
| D1110 |
Prophylaxis - adult |
513 |
505 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,311 |
4,238 |
$26K |
| D2335 |
|
109 |
62 |
$16K |
| D2330 |
|
142 |
84 |
$12K |