| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
4,256 |
2,009 |
$665K |
| D1120 |
Prophylaxis - child |
8,656 |
8,489 |
$358K |
| D0120 |
Periodic oral evaluation - established patient |
11,549 |
11,275 |
$323K |
| D1351 |
Sealant - per tooth |
3,562 |
1,415 |
$246K |
| D1110 |
Prophylaxis - adult |
5,373 |
5,250 |
$242K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,899 |
2,143 |
$233K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,351 |
8,190 |
$220K |
| D0274 |
Bitewings - four radiographic images |
10,504 |
10,260 |
$196K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,888 |
2,027 |
$192K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,306 |
17,520 |
$181K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,844 |
6,679 |
$162K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,587 |
1,820 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
20,302 |
19,628 |
$126K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
957 |
696 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
4,049 |
3,889 |
$73K |
| D1354 |
|
2,903 |
1,287 |
$67K |
| D9110 |
|
568 |
558 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
482 |
355 |
$28K |
| D2750 |
|
56 |
38 |
$11K |
| D0272 |
Bitewings - two radiographic images |
805 |
789 |
$8K |
| D4342 |
|
34 |
20 |
$5K |
| D2332 |
|
55 |
32 |
$5K |
| D2335 |
|
32 |
28 |
$4K |
| D2950 |
|
54 |
48 |
$3K |
| D2394 |
|
28 |
25 |
$3K |
| D4910 |
|
36 |
36 |
$2K |
| D0330 |
Panoramic radiographic image |
102 |
98 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
13 |
12 |
$978.08 |
| D8999 |
|
20 |
20 |
$893.95 |
| D9630 |
|
23 |
22 |
$540.50 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$166.95 |
| D1999 |
|
34 |
17 |
$0.00 |