| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
10,274 |
1,465 |
$243K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,136 |
642 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,296 |
3,450 |
$77K |
| D0274 |
Bitewings - four radiographic images |
2,962 |
2,718 |
$77K |
| D1110 |
Prophylaxis - adult |
1,760 |
1,630 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,776 |
2,563 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,661 |
4,072 |
$53K |
| D1120 |
Prophylaxis - child |
1,676 |
1,532 |
$49K |
| D0330 |
Panoramic radiographic image |
1,012 |
920 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
563 |
339 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,066 |
1,845 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,276 |
1,164 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
637 |
581 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
625 |
540 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
41 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
44 |
$7K |
| D0460 |
|
445 |
143 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
12 |
$3K |
| D2332 |
|
20 |
13 |
$2K |