| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2940 |
|
11,887 |
819 |
$408K |
| D2332 |
|
3,726 |
1,021 |
$365K |
| D2335 |
|
2,780 |
743 |
$310K |
| D4341 |
|
3,156 |
1,143 |
$272K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,776 |
776 |
$231K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,011 |
715 |
$141K |
| D2394 |
|
1,314 |
400 |
$126K |
| D4910 |
|
1,699 |
1,695 |
$106K |
| D2331 |
|
1,137 |
462 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,536 |
4,220 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,186 |
1,178 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,656 |
1,654 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,716 |
1,710 |
$45K |
| D1110 |
Prophylaxis - adult |
925 |
922 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,402 |
2,749 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
699 |
319 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,118 |
1,071 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,452 |
1,969 |
$30K |
| D0274 |
Bitewings - four radiographic images |
820 |
817 |
$22K |
| D0603 |
|
2,814 |
2,692 |
$22K |
| D1120 |
Prophylaxis - child |
344 |
343 |
$13K |
| D4342 |
|
206 |
90 |
$13K |
| D9110 |
|
208 |
204 |
$9K |
| D2330 |
|
68 |
38 |
$4K |
| D1330 |
|
3,308 |
3,181 |
$4K |
| D1320 |
|
351 |
344 |
$3K |
| D0270 |
|
250 |
243 |
$3K |
| D1351 |
Sealant - per tooth |
67 |
14 |
$2K |
| D1999 |
|
992 |
855 |
$1K |
| D1310 |
|
1,081 |
1,078 |
$510.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$228.00 |
| D0431 |
|
315 |
315 |
$0.00 |
| D4921 |
|
44 |
15 |
$0.00 |