| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
3,688 |
1,237 |
$534K |
| D1351 |
Sealant - per tooth |
7,028 |
2,811 |
$442K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,570 |
2,458 |
$380K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,819 |
2,388 |
$373K |
| D1120 |
Prophylaxis - child |
8,730 |
8,389 |
$351K |
| D0120 |
Periodic oral evaluation - established patient |
11,515 |
10,845 |
$313K |
| D1206 |
Topical application of fluoride varnish |
8,009 |
7,721 |
$203K |
| D1110 |
Prophylaxis - adult |
4,453 |
4,272 |
$189K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,932 |
2,153 |
$186K |
| D0274 |
Bitewings - four radiographic images |
8,448 |
8,037 |
$142K |
| D2332 |
|
1,209 |
754 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,963 |
4,765 |
$111K |
| D4342 |
|
636 |
367 |
$96K |
| D0220 |
Intraoral - periapical first radiographic image |
14,151 |
13,244 |
$83K |
| D0330 |
Panoramic radiographic image |
2,988 |
2,870 |
$68K |
| D5120 |
|
141 |
140 |
$60K |
| D5110 |
|
149 |
147 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,592 |
12,549 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
576 |
432 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,743 |
2,554 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
266 |
165 |
$21K |
| D2330 |
|
277 |
189 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
562 |
527 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
813 |
798 |
$14K |
| D2335 |
|
112 |
87 |
$10K |
| D2331 |
|
66 |
51 |
$5K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
13 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
131 |
125 |
$2K |
| D2950 |
|
45 |
39 |
$2K |
| D0270 |
|
142 |
128 |
$795.20 |
| D1999 |
|
1,017 |
857 |
$0.00 |