| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
20,716 |
4,985 |
$431K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,475 |
3,975 |
$430K |
| D1120 |
Prophylaxis - child |
15,432 |
14,710 |
$395K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,076 |
23,943 |
$379K |
| D1110 |
Prophylaxis - adult |
9,497 |
9,121 |
$313K |
| D0120 |
Periodic oral evaluation - established patient |
15,862 |
15,201 |
$296K |
| D0274 |
Bitewings - four radiographic images |
13,019 |
12,405 |
$263K |
| D0210 |
Intraoral - complete series of radiographic images |
5,095 |
4,845 |
$253K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,346 |
9,784 |
$242K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,785 |
2,640 |
$212K |
| D0220 |
Intraoral - periapical first radiographic image |
14,504 |
13,866 |
$134K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,847 |
12,571 |
$95K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,238 |
1,116 |
$89K |
| D0272 |
Bitewings - two radiographic images |
3,806 |
3,644 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
580 |
408 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
348 |
215 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,026 |
966 |
$20K |
| D0470 |
|
271 |
266 |
$10K |
| D0330 |
Panoramic radiographic image |
103 |
101 |
$5K |
| D2331 |
|
119 |
50 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
90 |
76 |
$4K |
| D2394 |
|
16 |
14 |
$1K |
| D2335 |
|
20 |
13 |
$1K |
| D2330 |
|
26 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$234.65 |