| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,673 |
949 |
$137K |
| D0140 |
Limited oral evaluation - problem focused |
3,647 |
3,424 |
$118K |
| D1120 |
Prophylaxis - child |
3,037 |
2,831 |
$116K |
| D1206 |
Topical application of fluoride varnish |
4,590 |
4,424 |
$94K |
| D1110 |
Prophylaxis - adult |
1,662 |
1,578 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
3,580 |
3,367 |
$90K |
| D0330 |
Panoramic radiographic image |
1,050 |
978 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,444 |
1,383 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,729 |
2,436 |
$47K |
| D0350 |
|
2,136 |
2,060 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
161 |
120 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
912 |
821 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
73 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
293 |
279 |
$10K |
| D1354 |
|
157 |
68 |
$9K |
| D0272 |
Bitewings - two radiographic images |
263 |
255 |
$7K |
| D9630 |
|
142 |
132 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
111 |
54 |
$891.00 |