| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
2,466 |
1,936 |
$1.54M |
| D1110 |
Prophylaxis - adult |
7,374 |
7,349 |
$394K |
| D0120 |
Periodic oral evaluation - established patient |
7,804 |
7,776 |
$226K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,160 |
2,115 |
$224K |
| D2954 |
|
1,705 |
1,442 |
$212K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
318 |
304 |
$191K |
| D0330 |
Panoramic radiographic image |
3,021 |
3,009 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,928 |
2,916 |
$122K |
| D0140 |
Limited oral evaluation - problem focused |
4,437 |
4,233 |
$118K |
| D0274 |
Bitewings - four radiographic images |
4,819 |
4,806 |
$104K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
836 |
445 |
$103K |
| D1120 |
Prophylaxis - child |
2,844 |
2,834 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
8,873 |
8,011 |
$84K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
952 |
710 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,206 |
938 |
$69K |
| D3320 |
|
121 |
110 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
631 |
339 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,460 |
2,453 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,558 |
3,034 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
366 |
364 |
$28K |
| D2950 |
|
244 |
193 |
$19K |
| D0272 |
Bitewings - two radiographic images |
705 |
703 |
$10K |
| D2335 |
|
80 |
57 |
$8K |
| D1206 |
Topical application of fluoride varnish |
88 |
88 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
26 |
$2K |
| D2394 |
|
19 |
14 |
$2K |
| D2332 |
|
16 |
12 |
$1K |
| D2330 |
|
21 |
12 |
$1K |
| D2331 |
|
20 |
14 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
55 |
52 |
$932.40 |
| D3221 |
|
27 |
24 |
$631.80 |
| D9430 |
|
39 |
36 |
$491.40 |
| D2920 |
|
16 |
14 |
$140.40 |
| D1999 |
|
1,018 |
846 |
$0.00 |