| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,653 |
782 |
$232K |
| D1351 |
Sealant - per tooth |
3,421 |
1,086 |
$177K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,256 |
1,229 |
$147K |
| D1120 |
Prophylaxis - child |
3,253 |
3,244 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,531 |
4,519 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,238 |
3,228 |
$87K |
| D0274 |
Bitewings - four radiographic images |
3,549 |
3,532 |
$68K |
| D1110 |
Prophylaxis - adult |
1,366 |
1,357 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
571 |
411 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,763 |
1,748 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,706 |
4,666 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,017 |
4,285 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
669 |
652 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
218 |
92 |
$12K |
| D2331 |
|
96 |
70 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
166 |
121 |
$7K |
| D2332 |
|
67 |
43 |
$7K |
| D0272 |
Bitewings - two radiographic images |
481 |
481 |
$5K |
| D4910 |
|
73 |
73 |
$5K |
| D1999 |
|
545 |
494 |
$0.00 |