| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,956 |
1,165 |
$425K |
| D0120 |
Periodic oral evaluation - established patient |
7,735 |
7,399 |
$206K |
| D1120 |
Prophylaxis - child |
3,669 |
3,562 |
$146K |
| D1110 |
Prophylaxis - adult |
3,517 |
3,387 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,864 |
1,447 |
$117K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,443 |
1,232 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
4,019 |
3,676 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,202 |
2,087 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,308 |
2,243 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
997 |
798 |
$49K |
| D0330 |
Panoramic radiographic image |
1,779 |
1,736 |
$40K |
| D2332 |
|
328 |
244 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,200 |
1,198 |
$32K |
| D1351 |
Sealant - per tooth |
354 |
180 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,529 |
2,464 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,917 |
2,748 |
$17K |
| D0274 |
Bitewings - four radiographic images |
945 |
900 |
$16K |
| D2950 |
|
203 |
178 |
$13K |
| D2394 |
|
130 |
127 |
$12K |
| D4910 |
|
154 |
154 |
$8K |
| D2331 |
|
116 |
85 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
373 |
356 |
$2K |
| D2330 |
|
17 |
12 |
$1K |
| D2940 |
|
38 |
37 |
$406.80 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$67.60 |