| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
279 |
167 |
$44K |
| D1351 |
Sealant - per tooth |
265 |
152 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
306 |
238 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
726 |
706 |
$20K |
| D1120 |
Prophylaxis - child |
486 |
474 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
500 |
488 |
$13K |
| D0274 |
Bitewings - four radiographic images |
643 |
629 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
461 |
451 |
$10K |
| D1110 |
Prophylaxis - adult |
228 |
227 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
178 |
148 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,440 |
1,361 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
107 |
89 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
107 |
98 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,215 |
1,131 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
380 |
359 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
140 |
118 |
$6K |
| D2332 |
|
53 |
39 |
$6K |
| D0270 |
|
328 |
320 |
$2K |
| D2335 |
|
15 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
53 |
53 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
19 |
$1K |
| D0272 |
Bitewings - two radiographic images |
96 |
94 |
$944.02 |
| D2160 |
|
14 |
13 |
$901.70 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
13 |
$325.18 |