| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
16,733 |
2,650 |
$417K |
| D1120 |
Prophylaxis - child |
11,205 |
9,511 |
$270K |
| D1206 |
Topical application of fluoride varnish |
8,318 |
6,982 |
$162K |
| D0120 |
Periodic oral evaluation - established patient |
5,948 |
5,388 |
$150K |
| D0330 |
Panoramic radiographic image |
4,242 |
3,522 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,180 |
3,983 |
$133K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,933 |
739 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
977 |
445 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,667 |
567 |
$80K |
| D0272 |
Bitewings - two radiographic images |
4,850 |
4,045 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
2,078 |
1,687 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,503 |
2,260 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
686 |
544 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,413 |
1,126 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,967 |
2,325 |
$26K |
| D8670 |
Periodic orthodontic treatment visit |
101 |
96 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,731 |
727 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
39 |
$7K |
| D1110 |
Prophylaxis - adult |
251 |
201 |
$5K |
| D9310 |
|
15 |
14 |
$515.26 |
| D1330 |
|
38 |
32 |
$0.00 |