| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
3,151 |
1,022 |
$460K |
| D1351 |
Sealant - per tooth |
5,685 |
2,076 |
$311K |
| D1120 |
Prophylaxis - child |
5,499 |
5,337 |
$223K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,953 |
1,452 |
$207K |
| D0120 |
Periodic oral evaluation - established patient |
6,671 |
6,486 |
$178K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,055 |
1,367 |
$139K |
| D1206 |
Topical application of fluoride varnish |
5,059 |
4,959 |
$131K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,459 |
1,107 |
$124K |
| D1110 |
Prophylaxis - adult |
2,464 |
2,398 |
$110K |
| D2332 |
|
980 |
567 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,931 |
3,792 |
$95K |
| D0274 |
Bitewings - four radiographic images |
5,272 |
5,071 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,029 |
797 |
$92K |
| D5110 |
|
200 |
199 |
$87K |
| D0330 |
Panoramic radiographic image |
3,735 |
3,648 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,691 |
1,076 |
$72K |
| D5120 |
|
160 |
159 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
5,474 |
5,219 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
1,172 |
1,163 |
$28K |
| D4342 |
|
153 |
111 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,263 |
1,217 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,034 |
4,791 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,187 |
1,139 |
$12K |
| D2330 |
|
167 |
114 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
379 |
323 |
$9K |
| D2740 |
Crown - porcelain/ceramic |
30 |
12 |
$9K |
| D2335 |
|
62 |
50 |
$7K |
| D2331 |
|
100 |
67 |
$6K |
| D2950 |
|
28 |
13 |
$2K |
| D2940 |
|
34 |
31 |
$429.40 |
| D0270 |
|
54 |
47 |
$263.20 |