| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
3,646 |
1,991 |
$568K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,383 |
1,588 |
$344K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,402 |
1,149 |
$274K |
| D2332 |
|
1,887 |
666 |
$237K |
| D1351 |
Sealant - per tooth |
1,893 |
692 |
$114K |
| D2335 |
|
765 |
355 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,025 |
2,867 |
$82K |
| D1120 |
Prophylaxis - child |
1,950 |
1,838 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,167 |
2,985 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
942 |
612 |
$70K |
| D0330 |
Panoramic radiographic image |
2,458 |
2,364 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,881 |
1,772 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
1,568 |
1,394 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,626 |
1,564 |
$26K |
| D5110 |
|
60 |
58 |
$26K |
| D2394 |
|
231 |
141 |
$26K |
| D4342 |
|
190 |
92 |
$24K |
| D1110 |
Prophylaxis - adult |
483 |
472 |
$22K |
| D0272 |
Bitewings - two radiographic images |
2,183 |
2,003 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
554 |
527 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,506 |
1,411 |
$7K |
| D5120 |
|
16 |
16 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
45 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
539 |
481 |
$2K |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$327.60 |