| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2330 |
|
6,219 |
851 |
$474K |
| D4260 |
|
649 |
227 |
$339K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,018 |
934 |
$321K |
| D0350 |
|
20,284 |
4,712 |
$193K |
| D4341 |
|
2,504 |
724 |
$192K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,086 |
2,082 |
$139K |
| D1110 |
Prophylaxis - adult |
1,289 |
1,287 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,014 |
3,798 |
$70K |
| D0330 |
Panoramic radiographic image |
1,841 |
1,836 |
$54K |
| D9110 |
|
747 |
682 |
$46K |
| D9430 |
|
1,442 |
1,348 |
$46K |
| D4910 |
|
549 |
547 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,322 |
3,071 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,055 |
2,049 |
$34K |
| D1120 |
Prophylaxis - child |
470 |
470 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
279 |
279 |
$18K |
| D4261 |
|
27 |
12 |
$9K |
| D1351 |
Sealant - per tooth |
87 |
13 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
18 |
18 |
$345.60 |