| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
789 |
335 |
$122K |
| D1351 |
Sealant - per tooth |
1,656 |
625 |
$93K |
| D1120 |
Prophylaxis - child |
1,492 |
1,486 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
890 |
560 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,656 |
1,651 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
415 |
325 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,174 |
1,165 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,135 |
1,124 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
828 |
820 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
290 |
163 |
$27K |
| D2740 |
Crown - porcelain/ceramic |
72 |
54 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
527 |
334 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
314 |
195 |
$20K |
| D0274 |
Bitewings - four radiographic images |
984 |
980 |
$18K |
| D1110 |
Prophylaxis - adult |
298 |
296 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,072 |
2,023 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
578 |
568 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,756 |
1,630 |
$9K |
| D1206 |
Topical application of fluoride varnish |
278 |
278 |
$8K |
| D5110 |
|
13 |
13 |
$5K |
| D2950 |
|
67 |
51 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
61 |
57 |
$4K |
| D0272 |
Bitewings - two radiographic images |
315 |
312 |
$3K |
| D4342 |
|
19 |
13 |
$2K |
| D2332 |
|
23 |
12 |
$2K |
| D2335 |
|
19 |
12 |
$2K |