| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
7,115 |
2,055 |
$65K |
| D1351 |
Sealant - per tooth |
1,980 |
442 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,460 |
1,459 |
$40K |
| D2332 |
|
306 |
239 |
$37K |
| D1110 |
Prophylaxis - adult |
687 |
686 |
$36K |
| D4355 |
|
412 |
411 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,266 |
2,240 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
891 |
889 |
$21K |
| D0274 |
Bitewings - four radiographic images |
583 |
583 |
$20K |
| D4341 |
|
127 |
57 |
$20K |
| D1120 |
Prophylaxis - child |
462 |
461 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
202 |
150 |
$18K |
| D2750 |
|
28 |
17 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
294 |
292 |
$13K |
| D2950 |
|
66 |
49 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
211 |
211 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
82 |
28 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
12 |
$2K |