| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
2,062 |
1,100 |
$369K |
| D1120 |
Prophylaxis - child |
1,855 |
1,743 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,563 |
2,451 |
$71K |
| D1351 |
Sealant - per tooth |
840 |
445 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,791 |
1,685 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,640 |
1,497 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
1,232 |
1,071 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,331 |
1,253 |
$23K |
| D2740 |
Crown - porcelain/ceramic |
58 |
51 |
$21K |
| D1110 |
Prophylaxis - adult |
434 |
433 |
$21K |
| D0330 |
Panoramic radiographic image |
965 |
945 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
797 |
767 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
121 |
49 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,073 |
950 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,050 |
977 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
61 |
$6K |
| D2950 |
|
76 |
67 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
43 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$984.24 |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
17 |
$201.40 |