| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
11,471 |
1,691 |
$339K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,003 |
1,307 |
$269K |
| D1110 |
Prophylaxis - adult |
3,293 |
2,908 |
$172K |
| D2394 |
|
1,108 |
804 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,393 |
946 |
$153K |
| D0330 |
Panoramic radiographic image |
2,328 |
2,053 |
$149K |
| D1120 |
Prophylaxis - child |
3,858 |
3,303 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
5,515 |
4,756 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,338 |
920 |
$121K |
| D1206 |
Topical application of fluoride varnish |
5,496 |
4,638 |
$106K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,487 |
561 |
$106K |
| D9630 |
|
4,918 |
4,494 |
$96K |
| D0274 |
Bitewings - four radiographic images |
2,679 |
2,383 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
1,689 |
1,529 |
$60K |
| D1320 |
|
2,635 |
2,361 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,590 |
1,449 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
3,577 |
2,391 |
$41K |
| D0350 |
|
3,160 |
2,904 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,287 |
1,082 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,705 |
862 |
$15K |
| D1353 |
|
2,519 |
339 |
$15K |
| D2335 |
|
92 |
53 |
$14K |
| D2332 |
|
106 |
73 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
237 |
234 |
$6K |
| D4355 |
|
37 |
26 |
$2K |
| D2331 |
|
16 |
12 |
$1K |
| D2330 |
|
13 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
13 |
$492.28 |
| D3120 |
|
54 |
40 |
$448.00 |
| D0431 |
|
268 |
238 |
$0.00 |