| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,955 |
795 |
$717K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,087 |
3,235 |
$623K |
| D2394 |
|
5,931 |
1,597 |
$431K |
| D2335 |
|
3,433 |
1,271 |
$277K |
| D2332 |
|
2,069 |
1,195 |
$203K |
| D1110 |
Prophylaxis - adult |
3,353 |
3,328 |
$129K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,528 |
1,190 |
$117K |
| D2954 |
|
932 |
608 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,620 |
2,604 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,301 |
1,026 |
$54K |
| D0274 |
Bitewings - four radiographic images |
2,247 |
2,237 |
$49K |
| D0330 |
Panoramic radiographic image |
2,023 |
2,012 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
723 |
447 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
2,076 |
2,027 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,391 |
1,387 |
$29K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
111 |
88 |
$27K |
| D7240 |
Removal of impacted tooth - completely bony |
103 |
56 |
$20K |
| D2331 |
|
229 |
136 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,060 |
1,039 |
$11K |
| D3320 |
|
57 |
43 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
409 |
362 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
706 |
701 |
$4K |
| D0272 |
Bitewings - two radiographic images |
190 |
189 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
171 |
170 |
$2K |
| D4341 |
|
43 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
26 |
26 |
$772.51 |
| D7450 |
|
14 |
13 |
$0.00 |