| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
2,236 |
1,000 |
$451K |
| D1120 |
Prophylaxis - child |
8,240 |
8,016 |
$341K |
| D0120 |
Periodic oral evaluation - established patient |
9,521 |
9,287 |
$268K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,232 |
6,089 |
$164K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,900 |
1,506 |
$151K |
| D1351 |
Sealant - per tooth |
1,953 |
1,350 |
$127K |
| D2160 |
|
973 |
817 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,721 |
2,646 |
$65K |
| D1110 |
Prophylaxis - adult |
1,372 |
1,357 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
842 |
715 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
1,866 |
1,793 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
9,363 |
9,097 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,898 |
2,807 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,978 |
8,751 |
$45K |
| D0272 |
Bitewings - two radiographic images |
3,470 |
3,372 |
$35K |
| D2332 |
|
213 |
190 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
298 |
220 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,138 |
1,084 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
407 |
335 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
246 |
189 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
256 |
227 |
$16K |
| D2330 |
|
252 |
183 |
$16K |
| D0270 |
|
1,850 |
1,837 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
113 |
97 |
$9K |
| D4342 |
|
30 |
30 |
$8K |
| D2140 |
|
170 |
148 |
$6K |
| D0330 |
Panoramic radiographic image |
287 |
269 |
$6K |
| D2335 |
|
15 |
13 |
$2K |
| D9310 |
|
39 |
39 |
$666.90 |
| D9110 |
|
12 |
12 |
$660.00 |