| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,234 |
713 |
$183K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,502 |
963 |
$122K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,374 |
917 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
2,988 |
2,878 |
$82K |
| D1120 |
Prophylaxis - child |
1,857 |
1,789 |
$76K |
| D1351 |
Sealant - per tooth |
1,204 |
434 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,115 |
2,008 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,846 |
1,778 |
$48K |
| D0330 |
Panoramic radiographic image |
1,891 |
1,838 |
$42K |
| D1110 |
Prophylaxis - adult |
897 |
881 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
822 |
556 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
391 |
295 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
857 |
760 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,036 |
1,005 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,958 |
1,822 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
244 |
117 |
$15K |
| D5110 |
|
31 |
29 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,562 |
1,454 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
449 |
433 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
612 |
496 |
$3K |
| D2940 |
|
19 |
16 |
$214.70 |