| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
2,256 |
1,233 |
$326K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,463 |
2,108 |
$294K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,599 |
1,094 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
4,190 |
3,978 |
$115K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,685 |
809 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,467 |
1,003 |
$87K |
| D1120 |
Prophylaxis - child |
2,043 |
1,957 |
$83K |
| D1110 |
Prophylaxis - adult |
1,812 |
1,752 |
$81K |
| D1351 |
Sealant - per tooth |
1,258 |
462 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,915 |
2,723 |
$67K |
| D0330 |
Panoramic radiographic image |
2,757 |
2,621 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,997 |
1,912 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
1,493 |
1,365 |
$35K |
| D0272 |
Bitewings - two radiographic images |
3,079 |
2,868 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,433 |
1,388 |
$25K |
| D5110 |
|
46 |
44 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
534 |
521 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,720 |
1,594 |
$9K |
| D2332 |
|
64 |
35 |
$7K |
| D5120 |
|
13 |
13 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
70 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
300 |
237 |
$1K |
| D2394 |
|
20 |
14 |
$1K |