| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,642 |
635 |
$117K |
| D0330 |
Panoramic radiographic image |
2,485 |
2,436 |
$101K |
| D1110 |
Prophylaxis - adult |
1,912 |
1,871 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,590 |
2,545 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,298 |
617 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,654 |
2,601 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
552 |
308 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
543 |
310 |
$32K |
| D1120 |
Prophylaxis - child |
356 |
355 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
760 |
747 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
487 |
448 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,275 |
2,073 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
837 |
827 |
$12K |
| D2332 |
|
151 |
82 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
2,486 |
2,392 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
26 |
$2K |
| D2335 |
|
17 |
12 |
$1K |
| D2331 |
|
17 |
13 |
$856.35 |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$640.36 |
| D9986 |
|
19 |
17 |
$0.00 |