| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
321 |
150 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
701 |
435 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
744 |
426 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
919 |
837 |
$24K |
| D1120 |
Prophylaxis - child |
612 |
562 |
$24K |
| D1351 |
Sealant - per tooth |
404 |
147 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
845 |
777 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
568 |
534 |
$17K |
| D1110 |
Prophylaxis - adult |
380 |
345 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
578 |
534 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
262 |
138 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
134 |
103 |
$13K |
| D0274 |
Bitewings - four radiographic images |
517 |
454 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
392 |
343 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,098 |
939 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
779 |
626 |
$3K |
| D2332 |
|
15 |
12 |
$2K |
| D2335 |
|
14 |
13 |
$1K |
| D4910 |
|
27 |
27 |
$1K |