| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
2,457 |
1,144 |
$349K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,536 |
2,519 |
$325K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,850 |
2,109 |
$207K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,602 |
7,256 |
$155K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,630 |
2,035 |
$151K |
| D1351 |
Sealant - per tooth |
5,984 |
1,076 |
$148K |
| D1120 |
Prophylaxis - child |
3,787 |
3,628 |
$127K |
| D0210 |
Intraoral - complete series of radiographic images |
4,313 |
4,070 |
$115K |
| D0330 |
Panoramic radiographic image |
4,128 |
3,905 |
$94K |
| D1110 |
Prophylaxis - adult |
3,173 |
3,083 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
3,210 |
3,103 |
$74K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,196 |
706 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,981 |
2,863 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
3,096 |
2,959 |
$51K |
| D0274 |
Bitewings - four radiographic images |
3,575 |
3,410 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,166 |
478 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,422 |
3,183 |
$19K |
| D9110 |
|
403 |
376 |
$18K |
| D1206 |
Topical application of fluoride varnish |
727 |
699 |
$16K |
| D4355 |
|
241 |
225 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
22 |
17 |
$8K |
| D2950 |
|
107 |
84 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,824 |
1,549 |
$7K |
| D2394 |
|
99 |
69 |
$6K |
| D2330 |
|
112 |
97 |
$6K |
| D0272 |
Bitewings - two radiographic images |
510 |
489 |
$5K |
| D2335 |
|
77 |
36 |
$5K |
| D5120 |
|
14 |
12 |
$4K |
| D4342 |
|
24 |
12 |
$2K |
| D3310 |
|
17 |
14 |
$2K |
| D2332 |
|
38 |
24 |
$2K |
| D7230 |
|
14 |
12 |
$1K |
| D4910 |
|
15 |
15 |
$1K |
| D2331 |
|
20 |
13 |
$1K |
| D1310 |
|
262 |
243 |
$0.00 |
| D1330 |
|
285 |
264 |
$0.00 |
| D9215 |
|
90 |
35 |
$0.00 |