| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
2,906 |
1,473 |
$431K |
| D1120 |
Prophylaxis - child |
7,431 |
6,696 |
$302K |
| D1351 |
Sealant - per tooth |
4,811 |
1,912 |
$282K |
| D0120 |
Periodic oral evaluation - established patient |
9,606 |
8,622 |
$265K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,668 |
6,052 |
$172K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,982 |
1,197 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,364 |
977 |
$83K |
| D0274 |
Bitewings - four radiographic images |
4,530 |
4,107 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,872 |
2,591 |
$65K |
| D1110 |
Prophylaxis - adult |
1,172 |
1,037 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
7,000 |
6,289 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,951 |
5,533 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
1,264 |
1,125 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,218 |
1,076 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
304 |
220 |
$16K |
| D1206 |
Topical application of fluoride varnish |
619 |
527 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,580 |
1,424 |
$15K |
| D2140 |
|
431 |
252 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
224 |
182 |
$9K |
| D4342 |
|
96 |
48 |
$5K |
| D4910 |
|
57 |
56 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$1K |
| D1999 |
|
3,545 |
3,220 |
$0.00 |