| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4355 |
|
1,560 |
1,547 |
$92K |
| D4341 |
|
644 |
169 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
696 |
448 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,236 |
824 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,970 |
1,929 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,774 |
1,729 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,708 |
1,694 |
$47K |
| D2394 |
|
277 |
222 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,912 |
1,892 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
517 |
271 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,759 |
2,644 |
$30K |
| D1110 |
Prophylaxis - adult |
716 |
714 |
$29K |
| D1120 |
Prophylaxis - child |
755 |
745 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
239 |
176 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,075 |
1,068 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
593 |
573 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
16 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,272 |
731 |
$8K |
| D2950 |
|
35 |
26 |
$6K |
| D1351 |
Sealant - per tooth |
50 |
15 |
$1K |
| D0272 |
Bitewings - two radiographic images |
43 |
43 |
$967.93 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$450.00 |