| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
232 |
125 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
334 |
253 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
699 |
683 |
$19K |
| D1120 |
Prophylaxis - child |
466 |
464 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
339 |
273 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
248 |
192 |
$13K |
| D0274 |
Bitewings - four radiographic images |
657 |
641 |
$11K |
| D1110 |
Prophylaxis - adult |
259 |
252 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
479 |
471 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
445 |
440 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,431 |
1,370 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,243 |
1,161 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
287 |
281 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
28 |
$2K |
| D1351 |
Sealant - per tooth |
30 |
12 |
$2K |
| D0270 |
|
311 |
309 |
$2K |
| D0272 |
Bitewings - two radiographic images |
99 |
97 |
$923.59 |
| D0330 |
Panoramic radiographic image |
34 |
34 |
$832.98 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$364.07 |