| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2721 |
|
132 |
109 |
$133K |
| D0330 |
Panoramic radiographic image |
1,499 |
1,490 |
$132K |
| D1110 |
Prophylaxis - adult |
1,954 |
1,946 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,173 |
669 |
$120K |
| D1351 |
Sealant - per tooth |
2,780 |
609 |
$114K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,288 |
650 |
$104K |
| D1206 |
Topical application of fluoride varnish |
2,584 |
2,574 |
$87K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
555 |
265 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,711 |
1,702 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
758 |
340 |
$83K |
| D0274 |
Bitewings - four radiographic images |
1,603 |
1,597 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,075 |
1,922 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,159 |
1,113 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
2,547 |
2,417 |
$47K |
| D1330 |
|
1,255 |
1,250 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
996 |
994 |
$39K |
| D4341 |
|
163 |
49 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
255 |
193 |
$32K |
| D1120 |
Prophylaxis - child |
691 |
689 |
$32K |
| D2330 |
|
247 |
155 |
$23K |
| D2331 |
|
149 |
100 |
$18K |
| D7250 |
|
92 |
41 |
$16K |
| D1354 |
|
430 |
114 |
$14K |
| D0272 |
Bitewings - two radiographic images |
338 |
336 |
$14K |
| D9110 |
|
236 |
229 |
$12K |
| D0240 |
|
270 |
137 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$9K |
| D2950 |
|
29 |
29 |
$6K |
| D2140 |
|
56 |
27 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
42 |
24 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
142 |
123 |
$3K |
| D2335 |
|
20 |
14 |
$3K |
| D2332 |
|
19 |
13 |
$3K |