| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
242 |
128 |
$37K |
| D1120 |
Prophylaxis - child |
667 |
643 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
276 |
203 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
631 |
603 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
650 |
627 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
638 |
630 |
$15K |
| D1110 |
Prophylaxis - adult |
255 |
246 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
285 |
283 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
187 |
132 |
$8K |
| D0274 |
Bitewings - four radiographic images |
371 |
360 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
39 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
721 |
697 |
$4K |
| D1351 |
Sealant - per tooth |
68 |
28 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
198 |
191 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
510 |
494 |
$3K |
| D0272 |
Bitewings - two radiographic images |
136 |
129 |
$1K |