| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
362 |
240 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
4,701 |
4,635 |
$85K |
| D1110 |
Prophylaxis - adult |
3,688 |
3,629 |
$72K |
| D1120 |
Prophylaxis - child |
1,942 |
1,929 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,015 |
670 |
$38K |
| D0274 |
Bitewings - four radiographic images |
3,266 |
3,231 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
1,119 |
1,082 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
5,516 |
5,377 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
975 |
932 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
575 |
351 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,180 |
1,160 |
$18K |
| D2954 |
|
332 |
241 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,647 |
4,444 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
870 |
869 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
156 |
78 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
54 |
$4K |
| D0191 |
|
99 |
91 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
14 |
$923.00 |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$233.75 |
| D0190 |
|
13 |
13 |
$60.00 |