| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,178 |
1,592 |
$250K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,103 |
1,444 |
$213K |
| D1120 |
Prophylaxis - child |
4,886 |
4,663 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
5,519 |
5,281 |
$155K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,740 |
4,523 |
$124K |
| D4341 |
|
502 |
262 |
$85K |
| D0274 |
Bitewings - four radiographic images |
3,659 |
3,517 |
$65K |
| D1110 |
Prophylaxis - adult |
1,315 |
1,294 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
7,530 |
7,169 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,963 |
1,902 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
2,229 |
2,171 |
$40K |
| D9110 |
|
572 |
539 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,240 |
5,928 |
$31K |
| D0330 |
Panoramic radiographic image |
810 |
792 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,232 |
1,165 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
105 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
65 |
55 |
$4K |
| D0270 |
|
375 |
372 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
57 |
$415.98 |
| D1999 |
|
22 |
22 |
$0.00 |
| D0190 |
|
26 |
26 |
$0.00 |