| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
2,711 |
1,476 |
$1.18M |
| D1110 |
Prophylaxis - adult |
6,991 |
6,104 |
$357K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,451 |
1,312 |
$328K |
| D0140 |
Limited oral evaluation - problem focused |
6,622 |
5,323 |
$260K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,319 |
1,539 |
$237K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,858 |
3,158 |
$189K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,384 |
1,340 |
$183K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,930 |
7,058 |
$155K |
| D2954 |
|
1,725 |
1,120 |
$130K |
| D0330 |
Panoramic radiographic image |
2,403 |
1,852 |
$124K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
203 |
170 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
4,278 |
4,056 |
$109K |
| D0274 |
Bitewings - four radiographic images |
2,743 |
2,609 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,243 |
1,157 |
$80K |
| D5214 |
|
209 |
72 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
4,825 |
4,159 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,049 |
293 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,253 |
1,665 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
272 |
188 |
$31K |
| D1120 |
Prophylaxis - child |
790 |
781 |
$31K |
| D0460 |
|
1,236 |
1,129 |
$28K |
| D5213 |
|
193 |
31 |
$27K |
| D3110 |
|
1,000 |
577 |
$26K |
| D3320 |
|
39 |
28 |
$18K |
| D5212 |
|
13 |
12 |
$7K |
| D4249 |
|
18 |
15 |
$6K |
| D7250 |
|
23 |
12 |
$4K |
| D7230 |
|
19 |
12 |
$4K |