| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
9,617 |
2,604 |
$671K |
| D4260 |
|
1,334 |
368 |
$652K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,321 |
7,283 |
$476K |
| D0120 |
Periodic oral evaluation - established patient |
8,376 |
8,338 |
$403K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,134 |
1,860 |
$371K |
| D4910 |
|
4,076 |
4,070 |
$312K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,864 |
2,068 |
$256K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56,437 |
10,923 |
$227K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,086 |
1,785 |
$218K |
| D0330 |
Panoramic radiographic image |
6,512 |
6,475 |
$185K |
| D0274 |
Bitewings - four radiographic images |
8,058 |
8,015 |
$172K |
| D1120 |
Prophylaxis - child |
3,344 |
3,328 |
$148K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,873 |
1,001 |
$125K |
| D9430 |
|
3,370 |
3,193 |
$108K |
| D1110 |
Prophylaxis - adult |
1,155 |
1,152 |
$103K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,188 |
839 |
$94K |
| D2330 |
|
1,246 |
683 |
$94K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
192 |
187 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,678 |
8,653 |
$83K |
| D4342 |
|
1,607 |
600 |
$67K |
| D0350 |
|
6,606 |
2,577 |
$67K |
| D2740 |
Crown - porcelain/ceramic |
140 |
109 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
750 |
392 |
$43K |
| D9110 |
|
693 |
684 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,657 |
2,629 |
$32K |
| D4261 |
|
53 |
27 |
$18K |
| D2331 |
|
201 |
133 |
$16K |
| D2954 |
|
121 |
96 |
$13K |
| D3320 |
|
30 |
27 |
$11K |
| D2140 |
|
203 |
109 |
$11K |
| D3310 |
|
35 |
25 |
$11K |
| D2394 |
|
73 |
55 |
$6K |
| D2160 |
|
66 |
49 |
$5K |
| D2335 |
|
41 |
26 |
$5K |
| D2332 |
|
47 |
37 |
$4K |
| D0272 |
Bitewings - two radiographic images |
129 |
129 |
$2K |
| D9440 |
|
67 |
58 |
$833.00 |