| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
2,179 |
1,171 |
$347K |
| D1351 |
Sealant - per tooth |
4,257 |
1,829 |
$282K |
| D1120 |
Prophylaxis - child |
6,135 |
5,994 |
$247K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,433 |
1,813 |
$210K |
| D0120 |
Periodic oral evaluation - established patient |
5,582 |
5,450 |
$154K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,900 |
5,777 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,376 |
5,310 |
$129K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,564 |
1,070 |
$111K |
| D0274 |
Bitewings - four radiographic images |
6,366 |
6,271 |
$110K |
| D1110 |
Prophylaxis - adult |
2,071 |
2,056 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
10,835 |
10,558 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,082 |
9,832 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,765 |
1,698 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
283 |
197 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
393 |
336 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,511 |
1,490 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
450 |
450 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
166 |
125 |
$10K |
| D2332 |
|
46 |
26 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
35 |
24 |
$2K |
| D9110 |
|
25 |
24 |
$1K |