| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,970 |
707 |
$105K |
| D1120 |
Prophylaxis - child |
1,896 |
1,885 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,396 |
2,377 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,797 |
1,792 |
$47K |
| D4341 |
|
296 |
154 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
452 |
275 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,346 |
1,333 |
$25K |
| D1110 |
Prophylaxis - adult |
457 |
453 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
425 |
226 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
248 |
165 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,232 |
2,187 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
492 |
486 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,184 |
1,917 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
120 |
89 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
99 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
103 |
69 |
$7K |
| D2160 |
|
72 |
50 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
263 |
251 |
$5K |
| D0272 |
Bitewings - two radiographic images |
219 |
218 |
$2K |
| D1206 |
Topical application of fluoride varnish |
56 |
51 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$621.10 |
| D1999 |
|
104 |
101 |
$0.00 |