| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
294 |
96 |
$36K |
| D1120 |
Prophylaxis - child |
975 |
888 |
$35K |
| D4342 |
|
428 |
154 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
576 |
360 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,162 |
1,022 |
$29K |
| D1206 |
Topical application of fluoride varnish |
942 |
857 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
320 |
251 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
170 |
98 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
685 |
625 |
$13K |
| D0274 |
Bitewings - four radiographic images |
840 |
750 |
$12K |
| D1110 |
Prophylaxis - adult |
318 |
310 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,699 |
1,478 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
391 |
345 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,401 |
1,249 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
150 |
117 |
$5K |
| D0272 |
Bitewings - two radiographic images |
380 |
343 |
$3K |
| D0330 |
Panoramic radiographic image |
168 |
153 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
26 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
57 |
$471.30 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$364.00 |
| D1999 |
|
208 |
193 |
$0.00 |