| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,377 |
846 |
$144K |
| D1120 |
Prophylaxis - child |
2,160 |
2,158 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
2,612 |
2,603 |
$72K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
673 |
418 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,121 |
2,119 |
$56K |
| D1110 |
Prophylaxis - adult |
1,195 |
1,186 |
$56K |
| D5110 |
|
123 |
122 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
718 |
433 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
738 |
392 |
$48K |
| D2332 |
|
440 |
243 |
$48K |
| D4341 |
|
278 |
114 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,654 |
1,644 |
$41K |
| D0274 |
Bitewings - four radiographic images |
2,049 |
2,034 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,987 |
1,893 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
342 |
276 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
4,372 |
4,305 |
$28K |
| D5120 |
|
61 |
60 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,462 |
3,251 |
$23K |
| D2335 |
|
162 |
103 |
$19K |
| D4342 |
|
115 |
68 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
66 |
57 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
303 |
175 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
449 |
448 |
$10K |
| D0272 |
Bitewings - two radiographic images |
457 |
456 |
$5K |
| D2940 |
|
320 |
268 |
$4K |
| D3310 |
|
15 |
13 |
$3K |
| D0270 |
|
433 |
433 |
$2K |
| D2331 |
|
17 |
12 |
$1K |
| D2950 |
|
15 |
13 |
$1K |