| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
8,398 |
1,565 |
$220K |
| D1110 |
Prophylaxis - adult |
4,993 |
4,783 |
$169K |
| D0120 |
Periodic oral evaluation - established patient |
5,940 |
5,680 |
$114K |
| D0274 |
Bitewings - four radiographic images |
4,253 |
4,080 |
$111K |
| D1120 |
Prophylaxis - child |
2,721 |
2,625 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,092 |
557 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
875 |
532 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
841 |
461 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,444 |
2,378 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
4,875 |
4,619 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,060 |
1,925 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,413 |
3,581 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,921 |
1,907 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
746 |
739 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
610 |
567 |
$23K |
| D0272 |
Bitewings - two radiographic images |
910 |
874 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
25 |
$2K |
| D2331 |
|
22 |
13 |
$1K |
| D2330 |
|
25 |
12 |
$1K |
| D2335 |
|
14 |
12 |
$1K |
| D1999 |
|
15 |
12 |
$0.00 |