| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
5,118 |
2,208 |
$341K |
| D1120 |
Prophylaxis - child |
5,731 |
5,505 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
6,531 |
6,296 |
$180K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,359 |
4,194 |
$113K |
| D1110 |
Prophylaxis - adult |
2,537 |
2,480 |
$110K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,715 |
965 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
2,696 |
2,617 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,538 |
3,409 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,274 |
930 |
$78K |
| D4341 |
|
426 |
237 |
$62K |
| D0274 |
Bitewings - four radiographic images |
3,623 |
3,461 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,016 |
718 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
6,113 |
5,791 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,232 |
4,809 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,211 |
1,165 |
$21K |
| D1206 |
Topical application of fluoride varnish |
619 |
616 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
55 |
$6K |
| D0272 |
Bitewings - two radiographic images |
508 |
484 |
$5K |
| D0601 |
|
47 |
47 |
$0.00 |