| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
774 |
410 |
$137K |
| D1120 |
Prophylaxis - child |
2,801 |
2,743 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,453 |
3,351 |
$80K |
| D1351 |
Sealant - per tooth |
876 |
490 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,537 |
2,484 |
$67K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
800 |
481 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,744 |
2,678 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,724 |
1,697 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
2,659 |
2,594 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
5,700 |
5,484 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
314 |
277 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,463 |
3,371 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
106 |
82 |
$13K |
| D1110 |
Prophylaxis - adult |
233 |
233 |
$11K |
| D0330 |
Panoramic radiographic image |
365 |
357 |
$9K |
| D2750 |
|
24 |
14 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
97 |
88 |
$6K |
| D0272 |
Bitewings - two radiographic images |
516 |
512 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
42 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
54 |
40 |
$3K |
| D1206 |
Topical application of fluoride varnish |
93 |
93 |
$2K |
| D2950 |
|
19 |
14 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
32 |
$933.10 |
| D2140 |
|
17 |
13 |
$555.30 |
| D1203 |
|
14 |
12 |
$0.00 |