| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,250 |
600 |
$209K |
| D1120 |
Prophylaxis - child |
5,100 |
4,861 |
$201K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,828 |
1,146 |
$186K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,458 |
1,641 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
5,591 |
5,331 |
$148K |
| D1351 |
Sealant - per tooth |
2,139 |
816 |
$130K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,477 |
5,220 |
$129K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,034 |
715 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,323 |
4,180 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,849 |
1,181 |
$92K |
| D1110 |
Prophylaxis - adult |
2,065 |
2,008 |
$88K |
| D0330 |
Panoramic radiographic image |
2,824 |
2,711 |
$79K |
| D2335 |
|
395 |
167 |
$71K |
| D0274 |
Bitewings - four radiographic images |
3,390 |
3,230 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
1,915 |
1,812 |
$53K |
| D9110 |
|
1,062 |
1,002 |
$50K |
| D2332 |
|
277 |
154 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,951 |
1,897 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
6,271 |
5,865 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,942 |
4,513 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
368 |
221 |
$21K |
| D4355 |
|
229 |
218 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,049 |
1,020 |
$11K |
| D2394 |
|
83 |
55 |
$11K |
| D2331 |
|
42 |
37 |
$4K |
| D2330 |
|
45 |
38 |
$3K |
| D1354 |
|
25 |
16 |
$920.70 |
| D2140 |
|
12 |
12 |
$431.90 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$409.50 |
| D1999 |
|
109 |
79 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
31 |
31 |
$0.00 |