| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,696 |
927 |
$787K |
| D1110 |
Prophylaxis - adult |
3,428 |
3,392 |
$219K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,539 |
936 |
$204K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,002 |
617 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
3,258 |
3,232 |
$100K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
563 |
436 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,622 |
1,591 |
$89K |
| D2950 |
|
893 |
581 |
$75K |
| D1206 |
Topical application of fluoride varnish |
2,851 |
2,820 |
$72K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
617 |
218 |
$67K |
| D3320 |
|
101 |
87 |
$65K |
| D0330 |
Panoramic radiographic image |
1,401 |
1,372 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,204 |
1,149 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,313 |
2,285 |
$54K |
| D3310 |
|
57 |
41 |
$30K |
| D1120 |
Prophylaxis - child |
671 |
667 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,414 |
2,232 |
$26K |
| D4341 |
|
291 |
121 |
$26K |
| D2331 |
|
208 |
137 |
$24K |
| D2332 |
|
139 |
90 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
306 |
299 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,017 |
971 |
$12K |
| D2330 |
|
98 |
70 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
29 |
$8K |
| D1330 |
|
404 |
401 |
$2K |
| D4910 |
|
14 |
14 |
$756.00 |