| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,162 |
606 |
$226K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,853 |
1,362 |
$192K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,672 |
1,204 |
$122K |
| D1120 |
Prophylaxis - child |
2,838 |
2,709 |
$116K |
| D1351 |
Sealant - per tooth |
1,280 |
805 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
2,742 |
2,622 |
$77K |
| D2332 |
|
519 |
349 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,444 |
2,322 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,075 |
787 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,916 |
1,847 |
$46K |
| D1110 |
Prophylaxis - adult |
923 |
918 |
$42K |
| D0330 |
Panoramic radiographic image |
1,601 |
1,551 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
1,465 |
1,322 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,142 |
1,069 |
$21K |
| D9110 |
|
340 |
328 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,657 |
1,538 |
$15K |
| D0274 |
Bitewings - four radiographic images |
845 |
843 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,021 |
1,983 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
149 |
115 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,641 |
1,616 |
$7K |
| D1206 |
Topical application of fluoride varnish |
190 |
190 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
13 |
$2K |
| D4910 |
|
17 |
17 |
$1K |
| D0270 |
|
78 |
78 |
$431.20 |