| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
4,166 |
1,114 |
$292K |
| D4910 |
|
3,572 |
3,556 |
$272K |
| D0120 |
Periodic oral evaluation - established patient |
3,749 |
3,720 |
$235K |
| D1110 |
Prophylaxis - adult |
2,297 |
2,284 |
$202K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,954 |
1,695 |
$196K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,737 |
2,717 |
$174K |
| D2740 |
Crown - porcelain/ceramic |
326 |
215 |
$155K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,210 |
717 |
$143K |
| D0210 |
Intraoral - complete series of radiographic images |
2,295 |
2,278 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,135 |
686 |
$89K |
| D1120 |
Prophylaxis - child |
2,101 |
2,090 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,024 |
4,004 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,309 |
732 |
$70K |
| D0274 |
Bitewings - four radiographic images |
3,146 |
3,133 |
$62K |
| D9430 |
|
1,875 |
1,798 |
$59K |
| D1206 |
Topical application of fluoride varnish |
3,159 |
3,138 |
$53K |
| D0350 |
|
3,191 |
1,425 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,981 |
1,974 |
$24K |
| D2954 |
|
193 |
149 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,239 |
1,209 |
$14K |
| D4342 |
|
337 |
116 |
$14K |
| D2330 |
|
118 |
54 |
$9K |
| D3320 |
|
17 |
14 |
$6K |
| D2332 |
|
30 |
18 |
$3K |
| D0272 |
Bitewings - two radiographic images |
119 |
119 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
15 |
$1K |
| D1320 |
|
13 |
13 |
$202.50 |
| D1330 |
|
216 |
215 |
$0.00 |