| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
384 |
181 |
$53K |
| D1120 |
Prophylaxis - child |
1,097 |
1,079 |
$46K |
| D1351 |
Sealant - per tooth |
929 |
263 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,143 |
1,134 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,155 |
1,129 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,022 |
1,007 |
$27K |
| D1110 |
Prophylaxis - adult |
528 |
523 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,239 |
1,217 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
350 |
252 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
317 |
252 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,876 |
1,826 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,164 |
1,633 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
155 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
314 |
303 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
195 |
195 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
26 |
$3K |
| D0272 |
Bitewings - two radiographic images |
233 |
232 |
$2K |
| D1999 |
|
320 |
299 |
$0.00 |