| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
18,538 |
4,588 |
$599K |
| D1120 |
Prophylaxis - child |
8,474 |
8,238 |
$352K |
| D1206 |
Topical application of fluoride varnish |
14,185 |
13,779 |
$343K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,641 |
4,540 |
$237K |
| D0120 |
Periodic oral evaluation - established patient |
6,368 |
6,172 |
$180K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,274 |
678 |
$116K |
| D0272 |
Bitewings - two radiographic images |
5,593 |
5,436 |
$82K |
| D0274 |
Bitewings - four radiographic images |
2,269 |
2,197 |
$49K |
| D1330 |
|
8,038 |
7,793 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
340 |
240 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,947 |
2,792 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,671 |
2,519 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
391 |
391 |
$9K |
| D2330 |
|
66 |
37 |
$6K |
| D1110 |
Prophylaxis - adult |
87 |
86 |
$5K |
| D2331 |
|
43 |
31 |
$4K |
| D2335 |
|
47 |
28 |
$4K |