| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
393 |
169 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
613 |
342 |
$29K |
| D1120 |
Prophylaxis - child |
550 |
545 |
$23K |
| D1351 |
Sealant - per tooth |
355 |
153 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
659 |
658 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
252 |
169 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
552 |
547 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
241 |
168 |
$14K |
| D1110 |
Prophylaxis - adult |
287 |
287 |
$14K |
| D0274 |
Bitewings - four radiographic images |
702 |
698 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
525 |
518 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
117 |
74 |
$9K |
| D4342 |
|
54 |
31 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,166 |
1,148 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,001 |
991 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
307 |
296 |
$5K |
| D2330 |
|
81 |
58 |
$5K |
| D2331 |
|
42 |
28 |
$4K |
| D2332 |
|
33 |
24 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
42 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
127 |
127 |
$2K |
| D2335 |
|
19 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
136 |
135 |
$1K |
| D0270 |
|
45 |
45 |
$240.80 |