| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
12,362 |
4,879 |
$754K |
| D1120 |
Prophylaxis - child |
16,530 |
15,685 |
$662K |
| D0120 |
Periodic oral evaluation - established patient |
16,978 |
16,245 |
$464K |
| D4341 |
|
2,598 |
1,375 |
$416K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,952 |
15,111 |
$403K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,492 |
6,977 |
$164K |
| D0330 |
Panoramic radiographic image |
7,965 |
7,465 |
$159K |
| D1110 |
Prophylaxis - adult |
2,777 |
2,703 |
$117K |
| D0274 |
Bitewings - four radiographic images |
7,710 |
7,367 |
$114K |
| D1354 |
|
1,933 |
965 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
2,883 |
2,575 |
$46K |
| D8999 |
|
1,131 |
1,111 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
628 |
604 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,202 |
719 |
$8K |
| D8660 |
|
65 |
65 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
791 |
736 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
115 |
77 |
$5K |
| D9110 |
|
60 |
59 |
$3K |
| D0272 |
Bitewings - two radiographic images |
335 |
311 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
33 |
$2K |
| D4910 |
|
28 |
28 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
25 |
$2K |