| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
5,963 |
3,202 |
$898K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,210 |
4,191 |
$672K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,281 |
1,460 |
$303K |
| D0120 |
Periodic oral evaluation - established patient |
8,933 |
8,540 |
$244K |
| D1351 |
Sealant - per tooth |
3,536 |
1,262 |
$206K |
| D5110 |
|
503 |
487 |
$197K |
| D1120 |
Prophylaxis - child |
4,836 |
4,582 |
$193K |
| D5120 |
|
304 |
297 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,163 |
4,840 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,444 |
4,209 |
$113K |
| D0330 |
Panoramic radiographic image |
5,127 |
4,914 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,776 |
853 |
$90K |
| D1110 |
Prophylaxis - adult |
1,772 |
1,722 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,026 |
439 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
2,599 |
2,382 |
$62K |
| D0272 |
Bitewings - two radiographic images |
5,870 |
5,510 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,858 |
2,755 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
682 |
392 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,738 |
1,650 |
$29K |
| D7240 |
Removal of impacted tooth - completely bony |
167 |
125 |
$22K |
| D2740 |
Crown - porcelain/ceramic |
48 |
38 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,745 |
2,552 |
$15K |
| D7230 |
|
68 |
53 |
$7K |
| D2950 |
|
54 |
42 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
372 |
311 |
$2K |