| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
2,449 |
1,009 |
$414K |
| D0120 |
Periodic oral evaluation - established patient |
14,046 |
13,541 |
$388K |
| D1120 |
Prophylaxis - child |
9,136 |
8,842 |
$374K |
| D1351 |
Sealant - per tooth |
5,617 |
2,316 |
$334K |
| D1110 |
Prophylaxis - adult |
6,467 |
6,293 |
$286K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,348 |
3,060 |
$284K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,004 |
8,712 |
$234K |
| D0274 |
Bitewings - four radiographic images |
11,173 |
10,788 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,236 |
6,970 |
$168K |
| D4342 |
|
1,237 |
610 |
$160K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,223 |
1,664 |
$126K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,489 |
1,184 |
$125K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,384 |
1,115 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
16,431 |
15,701 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,610 |
13,942 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,962 |
1,538 |
$80K |
| D2332 |
|
765 |
584 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
2,525 |
2,361 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
2,328 |
2,226 |
$41K |
| D2740 |
Crown - porcelain/ceramic |
76 |
68 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,722 |
1,662 |
$16K |
| D4910 |
|
224 |
224 |
$14K |
| D2330 |
|
145 |
110 |
$8K |
| D0330 |
Panoramic radiographic image |
354 |
352 |
$6K |
| D2335 |
|
48 |
41 |
$5K |
| D9110 |
|
79 |
79 |
$4K |
| D2331 |
|
31 |
27 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
35 |
26 |
$2K |
| D0601 |
|
19 |
19 |
$2K |
| D2950 |
|
27 |
26 |
$2K |
| D0270 |
|
13 |
13 |
$72.80 |
| D1999 |
|
40 |
39 |
$0.00 |