| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,886 |
816 |
$267K |
| D1351 |
Sealant - per tooth |
2,181 |
912 |
$137K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,144 |
737 |
$97K |
| D1120 |
Prophylaxis - child |
1,996 |
1,903 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
2,827 |
2,585 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,971 |
1,875 |
$50K |
| D1110 |
Prophylaxis - adult |
1,033 |
1,016 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,958 |
1,866 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,610 |
2,430 |
$44K |
| D2750 |
|
149 |
89 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
440 |
326 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
5,130 |
4,741 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,653 |
4,240 |
$26K |
| D2950 |
|
291 |
185 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
277 |
208 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
332 |
236 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
721 |
693 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
175 |
123 |
$13K |
| D0330 |
Panoramic radiographic image |
377 |
363 |
$8K |
| D5120 |
|
13 |
13 |
$5K |
| D0272 |
Bitewings - two radiographic images |
482 |
459 |
$5K |
| D5110 |
|
12 |
12 |
$5K |
| D0270 |
|
810 |
745 |
$4K |
| D2332 |
|
61 |
39 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
204 |
185 |
$4K |
| D9110 |
|
63 |
63 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
29 |
$3K |
| D4355 |
|
99 |
96 |
$3K |
| D2752 |
|
12 |
12 |
$3K |
| D2331 |
|
37 |
26 |
$3K |
| D2140 |
|
57 |
40 |
$2K |
| D2330 |
|
38 |
28 |
$2K |