| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4355 |
|
2,048 |
2,005 |
$118K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,084 |
5,177 |
$109K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,703 |
761 |
$97K |
| D2332 |
|
1,043 |
857 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,402 |
3,389 |
$74K |
| D2335 |
|
701 |
547 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
5,993 |
5,882 |
$60K |
| D1110 |
Prophylaxis - adult |
1,446 |
1,433 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
727 |
497 |
$54K |
| D1120 |
Prophylaxis - child |
1,171 |
1,171 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,354 |
1,343 |
$37K |
| D7310 |
|
358 |
301 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,555 |
1,553 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,133 |
1,126 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,273 |
1,265 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
197 |
157 |
$16K |
| D1351 |
Sealant - per tooth |
503 |
119 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D2140 |
|
22 |
12 |
$1K |
| D2330 |
|
15 |
13 |
$899.20 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$614.70 |