| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,075 |
524 |
$234K |
| D0120 |
Periodic oral evaluation - established patient |
1,722 |
1,720 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
674 |
549 |
$47K |
| D1110 |
Prophylaxis - adult |
769 |
769 |
$36K |
| D1120 |
Prophylaxis - child |
826 |
826 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
432 |
344 |
$34K |
| D2740 |
Crown - porcelain/ceramic |
103 |
73 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,123 |
1,123 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
801 |
785 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,138 |
1,052 |
$21K |
| D1351 |
Sealant - per tooth |
230 |
129 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,133 |
1,133 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
669 |
669 |
$18K |
| D2950 |
|
183 |
141 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,048 |
2,022 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
126 |
93 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,654 |
1,645 |
$8K |
| D4910 |
|
108 |
108 |
$7K |
| D0330 |
Panoramic radiographic image |
142 |
142 |
$3K |
| D0270 |
|
436 |
429 |
$2K |
| D0272 |
Bitewings - two radiographic images |
142 |
141 |
$1K |
| D2940 |
|
56 |
46 |
$678.00 |
| D2330 |
|
13 |
12 |
$674.70 |