| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
21,193 |
4,102 |
$517K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,305 |
2,195 |
$328K |
| D0120 |
Periodic oral evaluation - established patient |
10,962 |
10,742 |
$306K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,144 |
2,110 |
$295K |
| D1110 |
Prophylaxis - adult |
5,429 |
5,344 |
$288K |
| D1120 |
Prophylaxis - child |
6,035 |
5,878 |
$210K |
| D2160 |
|
1,977 |
1,179 |
$192K |
| D0274 |
Bitewings - four radiographic images |
5,805 |
5,712 |
$192K |
| D0210 |
Intraoral - complete series of radiographic images |
2,864 |
2,786 |
$186K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,356 |
11,121 |
$161K |
| D2140 |
|
1,986 |
1,325 |
$112K |
| D0272 |
Bitewings - two radiographic images |
2,846 |
2,769 |
$62K |
| D0350 |
|
2,648 |
2,530 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,055 |
1,000 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,039 |
1,844 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,982 |
755 |
$16K |
| D0330 |
Panoramic radiographic image |
168 |
153 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
132 |
131 |
$2K |
| D0602 |
|
3,563 |
3,506 |
$0.00 |
| D0603 |
|
2,447 |
2,401 |
$0.00 |
| D0601 |
|
8,116 |
7,968 |
$0.00 |