| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,890 |
819 |
$267K |
| D0140 |
Limited oral evaluation - problem focused |
3,662 |
2,885 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
781 |
449 |
$96K |
| D2740 |
Crown - porcelain/ceramic |
248 |
132 |
$86K |
| D0330 |
Panoramic radiographic image |
1,761 |
1,609 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,093 |
1,924 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
504 |
306 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,066 |
1,834 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
644 |
247 |
$45K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
93 |
76 |
$45K |
| D1110 |
Prophylaxis - adult |
772 |
707 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
287 |
151 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
101 |
71 |
$15K |
| D1206 |
Topical application of fluoride varnish |
657 |
603 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
525 |
504 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
775 |
630 |
$11K |
| D5225 |
|
14 |
12 |
$8K |
| D1354 |
|
368 |
69 |
$7K |
| D4355 |
|
48 |
44 |
$3K |
| D2950 |
|
23 |
12 |
$2K |
| D4910 |
|
16 |
12 |
$841.44 |
| D1120 |
Prophylaxis - child |
16 |
16 |
$545.44 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
15 |
$236.46 |