| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
22,323 |
8,596 |
$1.32M |
| D1120 |
Prophylaxis - child |
22,445 |
21,087 |
$888K |
| D4341 |
|
5,192 |
2,855 |
$825K |
| D0120 |
Periodic oral evaluation - established patient |
22,733 |
21,460 |
$617K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,936 |
19,671 |
$525K |
| D0330 |
Panoramic radiographic image |
13,582 |
12,675 |
$259K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,533 |
10,712 |
$246K |
| D0274 |
Bitewings - four radiographic images |
11,770 |
11,128 |
$167K |
| D1110 |
Prophylaxis - adult |
3,799 |
3,620 |
$150K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,111 |
1,482 |
$141K |
| D1354 |
|
4,529 |
2,488 |
$112K |
| D2140 |
|
1,845 |
1,292 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
4,726 |
4,244 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,557 |
1,108 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,108 |
832 |
$66K |
| D8999 |
|
1,905 |
1,862 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,570 |
2,840 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
3,731 |
3,543 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,227 |
1,172 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
337 |
235 |
$18K |
| D8660 |
|
192 |
185 |
$15K |
| D2950 |
|
228 |
165 |
$13K |
| D2332 |
|
127 |
98 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
128 |
101 |
$9K |
| D0272 |
Bitewings - two radiographic images |
1,031 |
960 |
$9K |
| D2750 |
|
24 |
24 |
$6K |
| D2160 |
|
67 |
55 |
$4K |
| D2331 |
|
53 |
38 |
$4K |
| D2335 |
|
47 |
39 |
$3K |
| D4910 |
|
25 |
25 |
$2K |
| D2330 |
|
15 |
13 |
$900.06 |