| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
7,810 |
3,160 |
$435K |
| D1120 |
Prophylaxis - child |
6,683 |
6,178 |
$263K |
| D0120 |
Periodic oral evaluation - established patient |
7,706 |
7,103 |
$205K |
| D1206 |
Topical application of fluoride varnish |
6,710 |
6,205 |
$168K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,165 |
1,142 |
$123K |
| D1354 |
|
4,348 |
2,373 |
$107K |
| D0274 |
Bitewings - four radiographic images |
3,485 |
3,186 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,577 |
819 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,325 |
6,168 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
6,812 |
6,182 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
506 |
309 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
1,050 |
976 |
$29K |
| D1110 |
Prophylaxis - adult |
985 |
914 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,442 |
2,246 |
$22K |
| D2332 |
|
235 |
162 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
505 |
468 |
$10K |
| D2335 |
|
132 |
95 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
44 |
$3K |
| D0603 |
|
796 |
612 |
$0.00 |