| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,276 |
2,587 |
$450K |
| D4341 |
|
2,091 |
863 |
$321K |
| D1120 |
Prophylaxis - child |
4,736 |
4,719 |
$198K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,794 |
1,272 |
$193K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,320 |
1,683 |
$175K |
| D0120 |
Periodic oral evaluation - established patient |
5,742 |
5,691 |
$159K |
| D5110 |
|
308 |
307 |
$131K |
| D2332 |
|
1,082 |
752 |
$117K |
| D1110 |
Prophylaxis - adult |
2,465 |
2,458 |
$116K |
| D4342 |
|
966 |
597 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,796 |
4,755 |
$115K |
| D0274 |
Bitewings - four radiographic images |
5,661 |
5,619 |
$111K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,120 |
892 |
$110K |
| D1206 |
Topical application of fluoride varnish |
4,030 |
4,024 |
$107K |
| D5120 |
|
214 |
213 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,495 |
1,061 |
$69K |
| D2331 |
|
724 |
582 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
8,682 |
8,561 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,385 |
7,906 |
$43K |
| D2335 |
|
376 |
286 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
392 |
256 |
$40K |
| D2330 |
|
606 |
441 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
2,037 |
1,978 |
$37K |
| D0330 |
Panoramic radiographic image |
1,512 |
1,493 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
737 |
727 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,277 |
1,272 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
494 |
480 |
$12K |
| D9999 |
Unspecified adjunctive procedure, by report |
28 |
25 |
$3K |