| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
52,488 |
8,565 |
$1.29M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,805 |
3,523 |
$485K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,261 |
18,258 |
$374K |
| D0274 |
Bitewings - four radiographic images |
13,758 |
13,078 |
$372K |
| D1110 |
Prophylaxis - adult |
8,757 |
8,318 |
$338K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,155 |
2,622 |
$275K |
| D0120 |
Periodic oral evaluation - established patient |
13,328 |
12,707 |
$275K |
| D0220 |
Intraoral - periapical first radiographic image |
23,283 |
20,790 |
$272K |
| D1120 |
Prophylaxis - child |
8,203 |
7,861 |
$247K |
| D0330 |
Panoramic radiographic image |
4,871 |
4,607 |
$182K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,807 |
9,873 |
$171K |
| D1206 |
Topical application of fluoride varnish |
8,523 |
7,659 |
$128K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,713 |
691 |
$118K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,444 |
925 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,875 |
3,651 |
$106K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
808 |
259 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,963 |
1,717 |
$48K |
| D0460 |
|
3,971 |
1,281 |
$46K |
| D2332 |
|
334 |
190 |
$28K |
| D0273 |
|
786 |
757 |
$18K |
| D2335 |
|
95 |
50 |
$9K |
| D0272 |
Bitewings - two radiographic images |
258 |
240 |
$5K |
| D2394 |
|
16 |
14 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$338.14 |
| D0270 |
|
13 |
12 |
$178.08 |
| D9986 |
|
24 |
24 |
$0.00 |
| D1999 |
|
78 |
71 |
$0.00 |