| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
2,354 |
1,116 |
$354K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,508 |
2,371 |
$271K |
| D1120 |
Prophylaxis - child |
2,608 |
2,492 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,757 |
4,495 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
3,220 |
3,053 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,500 |
804 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
2,612 |
2,456 |
$57K |
| D0330 |
Panoramic radiographic image |
2,691 |
2,580 |
$53K |
| D0274 |
Bitewings - four radiographic images |
3,570 |
3,339 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
808 |
501 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,043 |
1,957 |
$51K |
| D1110 |
Prophylaxis - adult |
1,041 |
1,001 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
2,132 |
1,982 |
$36K |
| D1351 |
Sealant - per tooth |
449 |
172 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
4,343 |
4,081 |
$24K |
| D9110 |
|
440 |
419 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,034 |
2,239 |
$19K |
| D5110 |
|
38 |
38 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
260 |
165 |
$10K |
| D5120 |
|
15 |
15 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
56 |
$5K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
17 |
13 |
$5K |
| D0272 |
Bitewings - two radiographic images |
214 |
207 |
$2K |
| D0240 |
|
38 |
19 |
$372.40 |
| D0603 |
|
59 |
59 |
$0.00 |