| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
2,433 |
1,087 |
$502K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,325 |
1,461 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
3,500 |
3,337 |
$96K |
| D1120 |
Prophylaxis - child |
2,167 |
2,055 |
$88K |
| D1110 |
Prophylaxis - adult |
1,965 |
1,881 |
$81K |
| D2740 |
Crown - porcelain/ceramic |
292 |
227 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,027 |
2,855 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,113 |
2,003 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
777 |
632 |
$46K |
| D1354 |
|
1,216 |
889 |
$34K |
| D0272 |
Bitewings - two radiographic images |
3,121 |
2,917 |
$28K |
| D2950 |
|
437 |
347 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
4,783 |
4,478 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,258 |
1,196 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
296 |
240 |
$21K |
| D1351 |
Sealant - per tooth |
259 |
119 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,055 |
3,737 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
413 |
303 |
$16K |
| D0330 |
Panoramic radiographic image |
508 |
486 |
$10K |
| D2331 |
|
87 |
56 |
$7K |
| D0274 |
Bitewings - four radiographic images |
359 |
356 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
12 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D9110 |
|
26 |
26 |
$1K |
| D1206 |
Topical application of fluoride varnish |
46 |
43 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
28 |
$508.50 |