| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,883 |
524 |
$128K |
| D8670 |
Periodic orthodontic treatment visit |
531 |
498 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
2,004 |
1,968 |
$92K |
| D1110 |
Prophylaxis - adult |
1,165 |
1,138 |
$84K |
| D0330 |
Panoramic radiographic image |
764 |
746 |
$80K |
| D1206 |
Topical application of fluoride varnish |
1,686 |
1,654 |
$64K |
| D9990 |
|
1,166 |
981 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,018 |
998 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
364 |
225 |
$42K |
| D1120 |
Prophylaxis - child |
754 |
749 |
$41K |
| D0350 |
|
305 |
302 |
$26K |
| D0340 |
|
191 |
189 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
911 |
821 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
194 |
125 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
203 |
197 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
531 |
288 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
39 |
$7K |
| D0272 |
Bitewings - two radiographic images |
114 |
114 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
27 |
$6K |
| D7111 |
|
19 |
13 |
$3K |