| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
494 |
373 |
$263K |
| D1110 |
Prophylaxis - adult |
3,736 |
3,633 |
$168K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,202 |
529 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,501 |
825 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
1,826 |
1,774 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,981 |
2,885 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,297 |
1,297 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,500 |
2,421 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,941 |
1,904 |
$44K |
| D2954 |
|
327 |
262 |
$30K |
| D0330 |
Panoramic radiographic image |
1,659 |
1,588 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
574 |
322 |
$22K |
| D0274 |
Bitewings - four radiographic images |
2,216 |
2,108 |
$18K |
| D1206 |
Topical application of fluoride varnish |
226 |
226 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
301 |
93 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,226 |
1,170 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
82 |
67 |
$4K |
| D1120 |
Prophylaxis - child |
66 |
66 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
73 |
44 |
$97.20 |