| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
43,432 |
5,221 |
$822K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,133 |
2,455 |
$319K |
| D1110 |
Prophylaxis - adult |
9,751 |
9,216 |
$292K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,540 |
1,686 |
$225K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,166 |
14,376 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
12,497 |
11,923 |
$190K |
| D0274 |
Bitewings - four radiographic images |
8,160 |
7,669 |
$153K |
| D1120 |
Prophylaxis - child |
5,480 |
5,252 |
$126K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,377 |
801 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,990 |
4,632 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
11,962 |
11,054 |
$99K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
859 |
490 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,678 |
914 |
$85K |
| D2332 |
|
1,043 |
539 |
$80K |
| D2335 |
|
822 |
445 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
3,285 |
3,019 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,231 |
5,949 |
$66K |
| D0272 |
Bitewings - two radiographic images |
3,816 |
3,676 |
$52K |
| D2394 |
|
338 |
240 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
498 |
477 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
259 |
140 |
$12K |
| D5110 |
|
12 |
12 |
$7K |
| D2160 |
|
122 |
68 |
$6K |
| D1206 |
Topical application of fluoride varnish |
219 |
216 |
$3K |
| D2330 |
|
17 |
12 |
$913.20 |
| D2940 |
|
19 |
13 |
$688.04 |
| D2140 |
|
29 |
13 |
$670.26 |
| D1999 |
|
2,136 |
1,831 |
$0.00 |