| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4260 |
|
3,402 |
920 |
$1.66M |
| D4341 |
|
12,248 |
3,288 |
$855K |
| D4910 |
|
9,275 |
9,194 |
$713K |
| D0120 |
Periodic oral evaluation - established patient |
9,842 |
9,789 |
$611K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,201 |
8,168 |
$527K |
| D0230 |
Intraoral - periapical each additional radiographic image |
102,294 |
19,038 |
$423K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,977 |
1,958 |
$348K |
| D0274 |
Bitewings - four radiographic images |
14,918 |
14,844 |
$317K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,582 |
2,300 |
$300K |
| D1110 |
Prophylaxis - adult |
3,227 |
3,218 |
$280K |
| D1120 |
Prophylaxis - child |
6,560 |
6,531 |
$263K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,190 |
1,765 |
$212K |
| D9110 |
|
3,014 |
2,935 |
$187K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,465 |
16,382 |
$172K |
| D2330 |
|
2,048 |
1,039 |
$156K |
| D2740 |
Crown - porcelain/ceramic |
250 |
207 |
$119K |
| D9430 |
|
3,614 |
3,339 |
$115K |
| D0330 |
Panoramic radiographic image |
3,670 |
3,647 |
$108K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,560 |
917 |
$89K |
| D0350 |
|
7,853 |
3,094 |
$79K |
| D4342 |
|
1,707 |
620 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
708 |
407 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,614 |
4,460 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
748 |
425 |
$50K |
| D2332 |
|
188 |
117 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,136 |
1,131 |
$13K |
| D2954 |
|
98 |
92 |
$10K |
| D2331 |
|
44 |
27 |
$4K |
| D2140 |
|
62 |
45 |
$3K |
| D1351 |
Sealant - per tooth |
39 |
12 |
$858.00 |
| D9440 |
|
14 |
13 |
$168.00 |