| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4260 |
|
1,803 |
476 |
$874K |
| D1110 |
Prophylaxis - adult |
5,372 |
5,354 |
$429K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,769 |
2,450 |
$391K |
| D4341 |
|
5,048 |
1,343 |
$362K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,831 |
5,816 |
$330K |
| D1351 |
Sealant - per tooth |
8,772 |
1,554 |
$289K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,092 |
2,085 |
$283K |
| D0210 |
Intraoral - complete series of radiographic images |
4,981 |
4,962 |
$251K |
| D0120 |
Periodic oral evaluation - established patient |
6,389 |
6,359 |
$244K |
| D1120 |
Prophylaxis - child |
5,901 |
5,877 |
$238K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,645 |
11,583 |
$153K |
| D4910 |
|
1,757 |
1,752 |
$140K |
| D0274 |
Bitewings - four radiographic images |
5,048 |
5,041 |
$114K |
| D0330 |
Panoramic radiographic image |
2,993 |
2,952 |
$97K |
| D2740 |
Crown - porcelain/ceramic |
189 |
158 |
$86K |
| D0350 |
|
8,813 |
2,745 |
$83K |
| D0365 |
|
256 |
256 |
$64K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
472 |
322 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,679 |
6,279 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
417 |
291 |
$36K |
| D0366 |
|
126 |
124 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,968 |
1,963 |
$28K |
| D2330 |
|
283 |
138 |
$21K |
| D0272 |
Bitewings - two radiographic images |
507 |
507 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
111 |
55 |
$6K |
| D2331 |
|
75 |
50 |
$6K |
| D2954 |
|
39 |
37 |
$4K |
| D9430 |
|
90 |
89 |
$3K |
| D0367 |
|
14 |
14 |
$0.00 |