| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,670 |
1,849 |
$285K |
| D4341 |
|
1,338 |
775 |
$198K |
| D1120 |
Prophylaxis - child |
4,723 |
4,603 |
$195K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,433 |
1,743 |
$162K |
| D0120 |
Periodic oral evaluation - established patient |
5,471 |
5,318 |
$153K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,427 |
4,317 |
$116K |
| D0210 |
Intraoral - complete series of radiographic images |
2,806 |
2,721 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,562 |
3,439 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,277 |
775 |
$74K |
| D1110 |
Prophylaxis - adult |
1,617 |
1,570 |
$71K |
| D0274 |
Bitewings - four radiographic images |
3,175 |
3,092 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
879 |
677 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
5,616 |
5,366 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
366 |
291 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,250 |
1,171 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,694 |
4,430 |
$21K |
| D0272 |
Bitewings - two radiographic images |
599 |
595 |
$6K |
| D1206 |
Topical application of fluoride varnish |
181 |
176 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
17 |
$2K |