| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
3,960 |
1,411 |
$289K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,267 |
2,699 |
$287K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,715 |
2,708 |
$283K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,342 |
1,892 |
$199K |
| D0330 |
Panoramic radiographic image |
4,732 |
4,514 |
$195K |
| D1110 |
Prophylaxis - adult |
4,183 |
3,999 |
$166K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,981 |
5,692 |
$160K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,026 |
1,336 |
$126K |
| D2335 |
|
1,612 |
873 |
$120K |
| D0274 |
Bitewings - four radiographic images |
4,592 |
4,364 |
$88K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,918 |
6,478 |
$54K |
| D2332 |
|
791 |
454 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
8,311 |
7,617 |
$45K |
| D2394 |
|
286 |
208 |
$19K |
| D2331 |
|
340 |
227 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,091 |
1,048 |
$16K |
| D5211 |
|
26 |
26 |
$16K |
| D2330 |
|
334 |
204 |
$15K |
| D5212 |
|
27 |
26 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
629 |
612 |
$12K |
| D1120 |
Prophylaxis - child |
138 |
133 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
14 |
$1K |
| D4346 |
|
14 |
14 |
$877.20 |
| D9110 |
|
27 |
26 |
$486.57 |