| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
232,769 |
66,739 |
$10.86M |
| D1355 |
|
72,116 |
9,698 |
$6.68M |
| D1351 |
Sealant - per tooth |
250,066 |
66,066 |
$5.92M |
| D1120 |
Prophylaxis - child |
194,013 |
179,988 |
$4.81M |
| D1206 |
Topical application of fluoride varnish |
188,125 |
174,443 |
$3.40M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104,878 |
97,066 |
$3.21M |
| D0120 |
Periodic oral evaluation - established patient |
106,277 |
98,697 |
$2.06M |
| D0272 |
Bitewings - two radiographic images |
119,222 |
110,360 |
$1.68M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,675 |
8,326 |
$800K |
| D1110 |
Prophylaxis - adult |
13,031 |
11,988 |
$552K |
| D0274 |
Bitewings - four radiographic images |
19,993 |
18,461 |
$501K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,305 |
4,561 |
$439K |
| D0220 |
Intraoral - periapical first radiographic image |
64,571 |
59,156 |
$426K |
| D0230 |
Intraoral - periapical each additional radiographic image |
69,657 |
53,121 |
$405K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,171 |
15,850 |
$209K |
| D0210 |
Intraoral - complete series of radiographic images |
453 |
346 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
202 |
146 |
$11K |
| D0270 |
|
720 |
659 |
$8K |
| D2330 |
|
86 |
53 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
62 |
$4K |
| D2140 |
|
54 |
25 |
$2K |
| D0350 |
|
51 |
12 |
$0.00 |