| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
12,608 |
2,348 |
$292K |
| D1110 |
Prophylaxis - adult |
5,174 |
5,019 |
$243K |
| D1120 |
Prophylaxis - child |
5,610 |
5,441 |
$188K |
| D0120 |
Periodic oral evaluation - established patient |
6,991 |
6,808 |
$172K |
| D1206 |
Topical application of fluoride varnish |
9,369 |
9,066 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,317 |
838 |
$164K |
| D0330 |
Panoramic radiographic image |
2,107 |
1,996 |
$122K |
| D9920 |
|
2,374 |
2,279 |
$116K |
| D0274 |
Bitewings - four radiographic images |
2,288 |
2,194 |
$67K |
| D0272 |
Bitewings - two radiographic images |
2,711 |
2,641 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
688 |
469 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
308 |
230 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
746 |
694 |
$28K |
| D1354 |
|
1,534 |
657 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
735 |
706 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
275 |
253 |
$11K |
| D1330 |
|
539 |
508 |
$11K |
| D2940 |
|
139 |
95 |
$8K |
| D4355 |
|
27 |
25 |
$2K |
| D2331 |
|
20 |
12 |
$2K |
| D1999 |
|
14 |
14 |
$0.00 |