| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,067 |
492 |
$144K |
| D1351 |
Sealant - per tooth |
2,765 |
882 |
$140K |
| D1120 |
Prophylaxis - child |
2,251 |
2,235 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
2,806 |
2,783 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,129 |
2,119 |
$57K |
| D1110 |
Prophylaxis - adult |
1,034 |
1,023 |
$49K |
| D0274 |
Bitewings - four radiographic images |
2,580 |
2,552 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,856 |
1,838 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
775 |
496 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
433 |
346 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
3,828 |
3,768 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,520 |
3,301 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
497 |
485 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
96 |
66 |
$7K |
| D0272 |
Bitewings - two radiographic images |
417 |
417 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
262 |
258 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
37 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$1K |
| D1999 |
|
652 |
612 |
$0.00 |