| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
9,032 |
4,044 |
$615K |
| D4341 |
|
3,038 |
1,792 |
$495K |
| D1120 |
Prophylaxis - child |
9,364 |
9,183 |
$381K |
| D0120 |
Periodic oral evaluation - established patient |
11,469 |
11,255 |
$315K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,656 |
1,581 |
$267K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,112 |
1,694 |
$176K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,436 |
6,413 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,307 |
1,394 |
$163K |
| D1110 |
Prophylaxis - adult |
3,597 |
3,503 |
$160K |
| D2332 |
|
1,316 |
814 |
$154K |
| D0274 |
Bitewings - four radiographic images |
6,759 |
6,662 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,888 |
4,797 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
12,013 |
11,722 |
$74K |
| D1206 |
Topical application of fluoride varnish |
2,798 |
2,641 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,617 |
10,787 |
$67K |
| D5110 |
|
145 |
143 |
$64K |
| D2335 |
|
507 |
341 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
423 |
348 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
1,992 |
1,969 |
$38K |
| D5120 |
|
78 |
78 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,970 |
1,931 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
670 |
498 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,642 |
2,570 |
$26K |
| D2330 |
|
263 |
185 |
$17K |
| D0330 |
Panoramic radiographic image |
679 |
615 |
$14K |
| D2331 |
|
97 |
79 |
$9K |
| D2394 |
|
26 |
17 |
$2K |
| D2950 |
|
30 |
25 |
$2K |
| D0270 |
|
187 |
178 |
$1K |
| D1999 |
|
2,307 |
2,200 |
$0.00 |