| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,809 |
880 |
$331K |
| D1120 |
Prophylaxis - child |
4,000 |
3,805 |
$158K |
| D0120 |
Periodic oral evaluation - established patient |
4,096 |
3,886 |
$112K |
| D1351 |
Sealant - per tooth |
1,605 |
740 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,026 |
2,872 |
$76K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
907 |
578 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,548 |
2,385 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
886 |
656 |
$40K |
| D0274 |
Bitewings - four radiographic images |
2,405 |
2,214 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
524 |
428 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
1,081 |
1,047 |
$30K |
| D1110 |
Prophylaxis - adult |
973 |
903 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
4,154 |
3,839 |
$23K |
| D1206 |
Topical application of fluoride varnish |
785 |
740 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
924 |
853 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,645 |
3,346 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,005 |
946 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
16 |
$1K |
| D4910 |
|
18 |
18 |
$1K |