| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
3,496 |
1,881 |
$666K |
| D1120 |
Prophylaxis - child |
12,400 |
12,018 |
$501K |
| D0120 |
Periodic oral evaluation - established patient |
15,791 |
15,275 |
$435K |
| D8670 |
Periodic orthodontic treatment visit |
1,771 |
1,686 |
$401K |
| D1351 |
Sealant - per tooth |
4,557 |
2,525 |
$393K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,936 |
11,566 |
$305K |
| D1354 |
|
7,384 |
4,413 |
$231K |
| D1110 |
Prophylaxis - adult |
5,183 |
5,027 |
$224K |
| D0274 |
Bitewings - four radiographic images |
12,109 |
11,645 |
$215K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,070 |
21,402 |
$199K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,880 |
1,581 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,653 |
2,214 |
$169K |
| D0220 |
Intraoral - periapical first radiographic image |
25,134 |
23,958 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,494 |
6,253 |
$146K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,668 |
1,331 |
$140K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,103 |
1,818 |
$97K |
| D0140 |
Limited oral evaluation - problem focused |
5,315 |
5,052 |
$93K |
| D9110 |
|
1,461 |
1,397 |
$79K |
| D2750 |
|
185 |
167 |
$48K |
| D2394 |
|
348 |
328 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
462 |
380 |
$23K |
| D0330 |
Panoramic radiographic image |
903 |
899 |
$22K |
| D2332 |
|
157 |
117 |
$18K |
| D2335 |
|
133 |
116 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,577 |
1,513 |
$15K |
| D4910 |
|
220 |
220 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
561 |
530 |
$10K |
| D4342 |
|
38 |
35 |
$10K |
| D2950 |
|
120 |
103 |
$8K |
| D8999 |
|
177 |
176 |
$8K |
| D2740 |
Crown - porcelain/ceramic |
28 |
24 |
$8K |
| D0601 |
|
303 |
299 |
$7K |
| D9630 |
|
179 |
175 |
$4K |
| D0270 |
|
518 |
514 |
$3K |
| D9310 |
|
130 |
126 |
$2K |
| D0602 |
|
62 |
60 |
$1K |
| D2330 |
|
18 |
14 |
$1K |
| D0603 |
|
28 |
28 |
$870.00 |
| D1999 |
|
143 |
74 |
$0.00 |