| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4342 |
|
2,437 |
616 |
$142K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
884 |
206 |
$74K |
| D2332 |
|
575 |
99 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
494 |
210 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,257 |
1,257 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
847 |
847 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,357 |
1,356 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
647 |
634 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
948 |
930 |
$7K |
| D0603 |
|
819 |
818 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
555 |
442 |
$3K |
| D1110 |
Prophylaxis - adult |
264 |
264 |
$2K |
| D0274 |
Bitewings - four radiographic images |
130 |
129 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
109 |
109 |
$1K |
| D1120 |
Prophylaxis - child |
108 |
108 |
$1K |
| D0602 |
|
130 |
130 |
$1K |
| D4910 |
|
14 |
14 |
$700.00 |
| D0601 |
|
42 |
42 |
$66.00 |
| D1330 |
|
119 |
119 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$0.00 |