| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
4,218 |
2,373 |
$633K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,372 |
2,417 |
$362K |
| D0120 |
Periodic oral evaluation - established patient |
5,936 |
5,638 |
$161K |
| D1120 |
Prophylaxis - child |
2,882 |
2,752 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,821 |
1,222 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,057 |
751 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,410 |
3,203 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,609 |
2,496 |
$66K |
| D0330 |
Panoramic radiographic image |
3,143 |
3,002 |
$66K |
| D1110 |
Prophylaxis - adult |
1,504 |
1,433 |
$65K |
| D1351 |
Sealant - per tooth |
845 |
303 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
1,944 |
1,783 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
754 |
274 |
$40K |
| D2740 |
Crown - porcelain/ceramic |
146 |
108 |
$40K |
| D0274 |
Bitewings - four radiographic images |
2,259 |
2,148 |
$37K |
| D0272 |
Bitewings - two radiographic images |
3,474 |
3,285 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
689 |
405 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,504 |
1,413 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,355 |
2,171 |
$13K |
| D5110 |
|
26 |
25 |
$10K |
| D2950 |
|
52 |
43 |
$3K |
| D2330 |
|
32 |
15 |
$2K |
| D7230 |
|
17 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
233 |
204 |
$921.07 |