| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2332 |
|
1,840 |
435 |
$145K |
| D1351 |
Sealant - per tooth |
2,671 |
870 |
$119K |
| D1120 |
Prophylaxis - child |
2,313 |
2,205 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,576 |
2,442 |
$65K |
| D1206 |
Topical application of fluoride varnish |
2,246 |
2,138 |
$54K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
704 |
371 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
726 |
430 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
968 |
452 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
725 |
457 |
$36K |
| D2335 |
|
368 |
171 |
$29K |
| D5110 |
|
80 |
79 |
$29K |
| D5120 |
|
73 |
72 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,298 |
1,240 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,727 |
1,644 |
$24K |
| D1110 |
Prophylaxis - adult |
653 |
606 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,641 |
3,133 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
3,777 |
3,577 |
$19K |
| D0330 |
Panoramic radiographic image |
876 |
806 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
346 |
258 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
648 |
602 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
987 |
950 |
$9K |
| D0272 |
Bitewings - two radiographic images |
711 |
664 |
$6K |
| D4341 |
|
17 |
13 |
$3K |
| D2331 |
|
33 |
30 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
34 |
34 |
$765.50 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
27 |
$670.00 |
| D0603 |
|
14 |
14 |
$140.00 |