| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,416 |
1,773 |
$259K |
| D1120 |
Prophylaxis - child |
6,168 |
5,874 |
$254K |
| D0120 |
Periodic oral evaluation - established patient |
6,493 |
6,210 |
$182K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,064 |
5,774 |
$158K |
| D0274 |
Bitewings - four radiographic images |
3,314 |
3,171 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,346 |
6,485 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
7,170 |
6,743 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
277 |
199 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
362 |
321 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
82 |
$7K |
| D0272 |
Bitewings - two radiographic images |
499 |
475 |
$5K |
| D1110 |
Prophylaxis - adult |
91 |
89 |
$4K |
| D9110 |
|
55 |
53 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$618.80 |