| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
79,073 |
16,653 |
$2.02M |
| D1120 |
Prophylaxis - child |
42,693 |
40,835 |
$1.59M |
| D1354 |
|
38,366 |
10,405 |
$1.55M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
35,078 |
33,332 |
$1.18M |
| D1208 |
Topical application of fluoride, excluding varnish |
49,908 |
47,391 |
$965K |
| D0230 |
Intraoral - periapical each additional radiographic image |
103,267 |
44,938 |
$871K |
| D0272 |
Bitewings - two radiographic images |
36,603 |
34,802 |
$695K |
| D0220 |
Intraoral - periapical first radiographic image |
48,630 |
46,249 |
$495K |
| D0120 |
Periodic oral evaluation - established patient |
19,290 |
18,257 |
$455K |
| D1110 |
Prophylaxis - adult |
6,722 |
6,274 |
$299K |
| D0274 |
Bitewings - four radiographic images |
3,961 |
3,691 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,479 |
825 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,551 |
873 |
$76K |
| D4346 |
|
404 |
351 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
858 |
710 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
521 |
471 |
$15K |
| D7250 |
|
40 |
17 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
15 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
24 |
$3K |
| D0270 |
|
13 |
13 |
$113.80 |
| D0603 |
|
3,302 |
3,092 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
100 |
81 |
$0.00 |