| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
4,423 |
1,240 |
$305K |
| D1110 |
Prophylaxis - adult |
3,189 |
3,163 |
$264K |
| D0120 |
Periodic oral evaluation - established patient |
4,378 |
4,366 |
$242K |
| D4910 |
|
2,957 |
2,922 |
$225K |
| D0230 |
Intraoral - periapical each additional radiographic image |
49,876 |
8,582 |
$209K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,173 |
2,162 |
$134K |
| D0220 |
Intraoral - periapical first radiographic image |
8,115 |
7,850 |
$95K |
| D1120 |
Prophylaxis - child |
2,490 |
2,481 |
$92K |
| D1206 |
Topical application of fluoride varnish |
4,209 |
4,178 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
862 |
597 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
858 |
578 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
605 |
450 |
$40K |
| D9110 |
|
537 |
527 |
$33K |
| D9430 |
|
983 |
937 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,540 |
2,524 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,378 |
2,369 |
$25K |
| D2330 |
|
156 |
112 |
$12K |
| D4342 |
|
254 |
97 |
$11K |
| D0274 |
Bitewings - four radiographic images |
335 |
335 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
141 |
141 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
13 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D1351 |
Sealant - per tooth |
130 |
47 |
$3K |
| D2952 |
|
16 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
18 |
$2K |
| D0350 |
|
120 |
81 |
$906.00 |