| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
3,256 |
2,147 |
$1.21M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,309 |
979 |
$400K |
| D1110 |
Prophylaxis - adult |
11,889 |
11,410 |
$303K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,840 |
2,994 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
12,711 |
12,160 |
$243K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,281 |
3,156 |
$211K |
| D1351 |
Sealant - per tooth |
13,427 |
2,107 |
$183K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,270 |
2,850 |
$179K |
| D1120 |
Prophylaxis - child |
7,145 |
6,804 |
$172K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,293 |
12,941 |
$169K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46,357 |
17,686 |
$165K |
| D2954 |
|
2,431 |
1,699 |
$161K |
| D3320 |
|
558 |
435 |
$135K |
| D0140 |
Limited oral evaluation - problem focused |
5,220 |
4,943 |
$129K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,274 |
1,255 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,712 |
6,467 |
$115K |
| D0220 |
Intraoral - periapical first radiographic image |
24,366 |
21,787 |
$82K |
| D2335 |
|
1,126 |
571 |
$71K |
| D2394 |
|
1,082 |
682 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,645 |
948 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
1,945 |
1,863 |
$52K |
| D2952 |
|
488 |
301 |
$47K |
| D2332 |
|
721 |
369 |
$30K |
| D1206 |
Topical application of fluoride varnish |
2,228 |
1,834 |
$24K |
| D2330 |
|
714 |
323 |
$23K |
| D9110 |
|
1,028 |
938 |
$13K |
| D5214 |
|
26 |
24 |
$11K |
| D3310 |
|
60 |
28 |
$10K |
| D0274 |
Bitewings - four radiographic images |
992 |
987 |
$9K |
| D5213 |
|
14 |
13 |
$7K |
| D0272 |
Bitewings - two radiographic images |
745 |
695 |
$5K |
| D5110 |
|
12 |
12 |
$4K |
| D2160 |
|
92 |
46 |
$3K |
| D1353 |
|
277 |
41 |
$2K |
| D2331 |
|
21 |
13 |
$790.00 |
| D2920 |
|
38 |
32 |
$388.25 |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$280.00 |
| D0350 |
|
58 |
47 |
$116.00 |
| D0270 |
|
39 |
28 |
$73.45 |
| D9310 |
|
12 |
12 |
$60.00 |
| D1999 |
|
1,372 |
1,256 |
$0.00 |
| D0431 |
|
155 |
149 |
$0.00 |
| D8660 |
|
16 |
16 |
$0.00 |
| D1320 |
|
173 |
167 |
$0.00 |
| D1330 |
|
329 |
319 |
$0.00 |