| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,642 |
646 |
$273K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,668 |
1,718 |
$236K |
| D1351 |
Sealant - per tooth |
2,165 |
1,066 |
$175K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,833 |
735 |
$141K |
| D4342 |
|
989 |
596 |
$126K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,187 |
741 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
4,230 |
4,084 |
$114K |
| D1120 |
Prophylaxis - child |
2,905 |
2,793 |
$113K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,072 |
833 |
$98K |
| D2332 |
|
811 |
552 |
$90K |
| D1110 |
Prophylaxis - adult |
1,804 |
1,789 |
$81K |
| D1206 |
Topical application of fluoride varnish |
2,801 |
2,694 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,174 |
844 |
$58K |
| D0274 |
Bitewings - four radiographic images |
3,429 |
3,295 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,416 |
2,300 |
$55K |
| D5110 |
|
121 |
121 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
5,576 |
5,210 |
$32K |
| D5120 |
|
69 |
69 |
$31K |
| D0330 |
Panoramic radiographic image |
1,582 |
1,540 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,380 |
1,319 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
1,110 |
958 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,878 |
4,562 |
$21K |
| D2330 |
|
265 |
189 |
$18K |
| D2335 |
|
89 |
62 |
$8K |
| D0272 |
Bitewings - two radiographic images |
833 |
784 |
$8K |
| D2331 |
|
85 |
65 |
$7K |