| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
11,430 |
1,418 |
$296K |
| D1120 |
Prophylaxis - child |
6,364 |
5,759 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,764 |
3,514 |
$136K |
| D0210 |
Intraoral - complete series of radiographic images |
1,640 |
1,483 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
2,177 |
1,915 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,793 |
4,127 |
$62K |
| D0272 |
Bitewings - two radiographic images |
3,678 |
3,196 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
671 |
369 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,342 |
2,039 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
760 |
519 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
340 |
226 |
$47K |
| D0330 |
Panoramic radiographic image |
1,119 |
1,008 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,626 |
1,580 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
1,530 |
1,368 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
406 |
360 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
14 |
$2K |