| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
2,715 |
846 |
$387K |
| D1351 |
Sealant - per tooth |
6,130 |
2,238 |
$370K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,368 |
1,836 |
$297K |
| D1120 |
Prophylaxis - child |
6,198 |
5,935 |
$250K |
| D0120 |
Periodic oral evaluation - established patient |
8,925 |
8,368 |
$245K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,921 |
1,209 |
$154K |
| D1206 |
Topical application of fluoride varnish |
5,723 |
5,496 |
$146K |
| D1110 |
Prophylaxis - adult |
3,033 |
2,895 |
$129K |
| D4342 |
|
491 |
358 |
$101K |
| D0274 |
Bitewings - four radiographic images |
5,464 |
5,141 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,096 |
2,919 |
$67K |
| D0330 |
Panoramic radiographic image |
2,697 |
2,553 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,118 |
720 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
9,881 |
9,260 |
$58K |
| D5110 |
|
140 |
137 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,541 |
8,786 |
$40K |
| D5120 |
|
76 |
74 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,481 |
2,351 |
$23K |
| D2332 |
|
185 |
128 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
756 |
730 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
393 |
367 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
129 |
100 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
13 |
$1K |
| D2330 |
|
19 |
12 |
$1K |
| D0270 |
|
184 |
166 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
111 |
100 |
$815.20 |
| D1999 |
|
1,049 |
879 |
$0.00 |