| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
3,770 |
1,449 |
$273K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,792 |
6,721 |
$188K |
| D0210 |
Intraoral - complete series of radiographic images |
3,090 |
3,053 |
$176K |
| D5110 |
|
265 |
262 |
$172K |
| D2394 |
|
2,373 |
1,080 |
$171K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,351 |
1,394 |
$150K |
| D1110 |
Prophylaxis - adult |
3,134 |
3,089 |
$146K |
| D2335 |
|
1,443 |
605 |
$110K |
| D5120 |
|
176 |
174 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,691 |
1,126 |
$99K |
| D0330 |
Panoramic radiographic image |
1,774 |
1,768 |
$91K |
| D2332 |
|
839 |
501 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,925 |
1,907 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,498 |
2,474 |
$39K |
| D1120 |
Prophylaxis - child |
657 |
649 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,166 |
2,130 |
$28K |
| D5130 |
|
45 |
42 |
$24K |
| D9110 |
|
396 |
378 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,597 |
2,562 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
636 |
533 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
220 |
60 |
$16K |
| D4381 |
|
118 |
44 |
$10K |
| D3110 |
|
672 |
268 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
330 |
328 |
$9K |
| D5212 |
|
12 |
12 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
13 |
$866.80 |
| D1999 |
|
27 |
24 |
$0.00 |
| D9995 |
|
26 |
22 |
$0.00 |