| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
520 |
258 |
$92K |
| D1120 |
Prophylaxis - child |
2,084 |
2,001 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
2,644 |
2,544 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,959 |
1,878 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,504 |
2,408 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,670 |
4,249 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
5,059 |
4,818 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,340 |
1,274 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
350 |
288 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
853 |
817 |
$19K |
| D1110 |
Prophylaxis - adult |
393 |
381 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
414 |
352 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
91 |
76 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
45 |
$3K |
| D1351 |
Sealant - per tooth |
28 |
14 |
$1K |
| D9110 |
|
13 |
13 |
$660.00 |
| D0272 |
Bitewings - two radiographic images |
60 |
52 |
$554.60 |
| D1354 |
|
22 |
16 |
$519.75 |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
36 |
$264.70 |
| D1999 |
|
26 |
16 |
$0.00 |