| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,500 |
658 |
$295K |
| D1120 |
Prophylaxis - child |
6,633 |
6,445 |
$272K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,275 |
2,186 |
$245K |
| D1351 |
Sealant - per tooth |
3,986 |
1,909 |
$234K |
| D0120 |
Periodic oral evaluation - established patient |
7,498 |
7,252 |
$210K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,593 |
6,407 |
$172K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,585 |
1,061 |
$155K |
| D4342 |
|
845 |
414 |
$111K |
| D0274 |
Bitewings - four radiographic images |
5,987 |
5,788 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,174 |
3,022 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,488 |
1,155 |
$69K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
726 |
560 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
9,938 |
9,493 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,833 |
8,822 |
$55K |
| D4910 |
|
602 |
600 |
$39K |
| D1110 |
Prophylaxis - adult |
676 |
656 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
415 |
329 |
$24K |
| D2332 |
|
167 |
100 |
$19K |
| D2330 |
|
220 |
131 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
692 |
638 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
762 |
743 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,286 |
1,238 |
$12K |
| D9110 |
|
120 |
118 |
$7K |
| D0330 |
Panoramic radiographic image |
341 |
336 |
$6K |
| D0601 |
|
32 |
32 |
$3K |
| D0603 |
|
25 |
25 |
$2K |
| D0602 |
|
12 |
12 |
$1K |
| D0270 |
|
13 |
13 |
$72.80 |
| D1999 |
|
37 |
36 |
$0.00 |