| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,679 |
2,766 |
$407K |
| D1120 |
Prophylaxis - child |
7,833 |
7,066 |
$317K |
| D4341 |
|
1,531 |
797 |
$245K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,247 |
1,911 |
$221K |
| D0120 |
Periodic oral evaluation - established patient |
7,929 |
7,135 |
$218K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,226 |
6,492 |
$186K |
| D0274 |
Bitewings - four radiographic images |
6,543 |
5,833 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,365 |
1,422 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,656 |
4,114 |
$100K |
| D1110 |
Prophylaxis - adult |
1,851 |
1,691 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
8,643 |
7,635 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,301 |
5,972 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,793 |
1,620 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
306 |
241 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,898 |
1,715 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
268 |
255 |
$5K |
| D4342 |
|
27 |
17 |
$1K |
| D1999 |
|
3,392 |
3,236 |
$20.00 |