| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9420 |
|
5,404 |
3,731 |
$673K |
| D4341 |
|
7,034 |
1,829 |
$522K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,832 |
3,494 |
$155K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,285 |
603 |
$155K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,159 |
459 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
967 |
964 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
3,504 |
3,472 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,077 |
1,066 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,230 |
1,227 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,692 |
1,677 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
297 |
133 |
$20K |
| D0350 |
|
1,770 |
749 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
125 |
44 |
$12K |
| D2330 |
|
51 |
25 |
$4K |
| D1120 |
Prophylaxis - child |
81 |
81 |
$3K |