| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,564 |
789 |
$109K |
| D7140 |
Extraction, erupted tooth or exposed root |
526 |
176 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,053 |
1,956 |
$37K |
| D1120 |
Prophylaxis - child |
1,134 |
1,075 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,573 |
1,522 |
$32K |
| D1110 |
Prophylaxis - adult |
818 |
793 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,824 |
1,741 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,344 |
2,215 |
$27K |
| D0274 |
Bitewings - four radiographic images |
889 |
860 |
$25K |
| D0272 |
Bitewings - two radiographic images |
667 |
626 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
182 |
72 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
412 |
377 |
$11K |
| D0330 |
Panoramic radiographic image |
180 |
170 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
89 |
42 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
132 |
128 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
15 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
26 |
$658.55 |
| D0350 |
|
81 |
80 |
$0.00 |
| D0601 |
|
160 |
157 |
$0.00 |
| D0602 |
|
370 |
360 |
$0.00 |