| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,781 |
757 |
$136K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,867 |
788 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,406 |
3,303 |
$101K |
| D1110 |
Prophylaxis - adult |
1,979 |
1,920 |
$94K |
| D0330 |
Panoramic radiographic image |
1,788 |
1,739 |
$87K |
| D0274 |
Bitewings - four radiographic images |
3,204 |
3,109 |
$84K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
600 |
372 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
693 |
293 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
736 |
701 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,080 |
1,058 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
415 |
150 |
$22K |
| D1120 |
Prophylaxis - child |
425 |
417 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,566 |
2,456 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,133 |
1,098 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,277 |
1,885 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
90 |
13 |
$13K |
| D5110 |
|
13 |
13 |
$9K |
| D2335 |
|
99 |
42 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
683 |
208 |
$6K |
| D2332 |
|
33 |
15 |
$2K |
| D9986 |
|
114 |
113 |
$309.00 |