| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
978 |
489 |
$151K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,595 |
1,133 |
$131K |
| D1120 |
Prophylaxis - child |
2,666 |
2,522 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
3,484 |
3,212 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,146 |
2,954 |
$74K |
| D1110 |
Prophylaxis - adult |
1,544 |
1,436 |
$67K |
| D1351 |
Sealant - per tooth |
993 |
364 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,192 |
2,083 |
$57K |
| D2740 |
Crown - porcelain/ceramic |
188 |
123 |
$54K |
| D0330 |
Panoramic radiographic image |
2,445 |
2,304 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
745 |
476 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,841 |
1,623 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,713 |
1,571 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
1,421 |
1,291 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
404 |
262 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
3,724 |
3,163 |
$17K |
| D2950 |
|
173 |
128 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
128 |
74 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,182 |
1,110 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,557 |
2,006 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
41 |
$4K |