| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
3,560 |
1,936 |
$588K |
| D1120 |
Prophylaxis - child |
7,833 |
7,537 |
$322K |
| D0120 |
Periodic oral evaluation - established patient |
9,347 |
9,031 |
$260K |
| D1351 |
Sealant - per tooth |
3,898 |
1,789 |
$252K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,686 |
1,897 |
$229K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,066 |
1,457 |
$144K |
| D1206 |
Topical application of fluoride varnish |
4,848 |
4,636 |
$126K |
| D0274 |
Bitewings - four radiographic images |
6,694 |
6,516 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,889 |
2,803 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,085 |
3,018 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
10,394 |
10,042 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
2,567 |
2,502 |
$46K |
| D1110 |
Prophylaxis - adult |
1,310 |
1,287 |
$46K |
| D2752 |
|
169 |
144 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,681 |
8,352 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
343 |
276 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,476 |
1,397 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
300 |
237 |
$13K |
| D9110 |
|
85 |
85 |
$5K |
| D2950 |
|
48 |
44 |
$3K |
| D4342 |
|
15 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
69 |
$2K |
| D0330 |
Panoramic radiographic image |
37 |
37 |
$945.41 |