| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
6,408 |
2,330 |
$892K |
| D1351 |
Sealant - per tooth |
12,011 |
5,103 |
$728K |
| D0120 |
Periodic oral evaluation - established patient |
23,551 |
22,317 |
$642K |
| D1120 |
Prophylaxis - child |
15,675 |
14,907 |
$629K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,210 |
3,982 |
$610K |
| D4342 |
|
3,340 |
1,616 |
$442K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,667 |
3,209 |
$400K |
| D2332 |
|
3,429 |
1,928 |
$325K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,784 |
2,738 |
$302K |
| D1206 |
Topical application of fluoride varnish |
11,123 |
10,741 |
$284K |
| D5110 |
|
629 |
610 |
$246K |
| D1110 |
Prophylaxis - adult |
5,323 |
5,039 |
$217K |
| D0274 |
Bitewings - four radiographic images |
13,805 |
13,035 |
$216K |
| D0220 |
Intraoral - periapical first radiographic image |
29,535 |
27,738 |
$170K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,536 |
1,274 |
$149K |
| D5120 |
|
351 |
333 |
$138K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,814 |
24,676 |
$130K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,531 |
4,148 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,125 |
3,840 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,701 |
1,209 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
4,257 |
4,048 |
$69K |
| D0272 |
Bitewings - two radiographic images |
6,549 |
6,195 |
$60K |
| D0330 |
Panoramic radiographic image |
3,373 |
3,227 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
2,761 |
2,597 |
$38K |
| D2330 |
|
40 |
27 |
$3K |
| D2950 |
|
13 |
12 |
$986.85 |
| D0270 |
|
47 |
47 |
$263.20 |
| D0601 |
|
247 |
244 |
$0.49 |
| D0602 |
|
14 |
14 |
$0.00 |
| D1999 |
|
1,785 |
1,502 |
$0.00 |