| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,874 |
827 |
$339K |
| D1351 |
Sealant - per tooth |
3,204 |
1,363 |
$197K |
| D1120 |
Prophylaxis - child |
4,114 |
3,994 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
5,106 |
4,971 |
$143K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,578 |
2,503 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
961 |
687 |
$67K |
| D0274 |
Bitewings - four radiographic images |
3,590 |
3,502 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,326 |
2,252 |
$53K |
| D1110 |
Prophylaxis - adult |
1,286 |
1,259 |
$51K |
| D1206 |
Topical application of fluoride varnish |
1,283 |
1,241 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
4,598 |
4,439 |
$28K |
| D4342 |
|
153 |
77 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
207 |
123 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,324 |
4,166 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
457 |
433 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
78 |
51 |
$8K |
| D0272 |
Bitewings - two radiographic images |
374 |
359 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
213 |
194 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
33 |
$2K |
| D4910 |
|
24 |
24 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$1K |