| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
836 |
346 |
$126K |
| D1351 |
Sealant - per tooth |
2,353 |
766 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,752 |
1,140 |
$118K |
| D1120 |
Prophylaxis - child |
2,960 |
2,845 |
$116K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,086 |
669 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
2,875 |
2,750 |
$76K |
| D1206 |
Topical application of fluoride varnish |
2,110 |
2,012 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,958 |
1,926 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,412 |
2,320 |
$39K |
| D1110 |
Prophylaxis - adult |
613 |
612 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
3,413 |
3,195 |
$18K |
| D2740 |
Crown - porcelain/ceramic |
62 |
41 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
532 |
525 |
$13K |
| D0330 |
Panoramic radiographic image |
616 |
606 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,447 |
2,670 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
716 |
675 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
137 |
74 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
217 |
165 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
452 |
449 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
163 |
101 |
$7K |
| D0272 |
Bitewings - two radiographic images |
658 |
615 |
$6K |
| D2950 |
|
77 |
52 |
$5K |
| D0270 |
|
311 |
295 |
$2K |
| D9110 |
|
29 |
29 |
$2K |
| D9310 |
|
38 |
38 |
$564.30 |