| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,501 |
1,034 |
$623K |
| D1110 |
Prophylaxis - adult |
11,576 |
11,574 |
$419K |
| D0210 |
Intraoral - complete series of radiographic images |
4,885 |
4,874 |
$171K |
| D0120 |
Periodic oral evaluation - established patient |
8,436 |
8,432 |
$166K |
| D0274 |
Bitewings - four radiographic images |
6,728 |
6,727 |
$129K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,096 |
1,494 |
$124K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
389 |
203 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,211 |
4,208 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
8,933 |
8,879 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,479 |
7,474 |
$43K |
| D2140 |
|
991 |
799 |
$42K |
| D4341 |
|
878 |
326 |
$35K |
| D2954 |
|
373 |
334 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,653 |
2,653 |
$29K |
| D2160 |
|
272 |
237 |
$19K |
| D2331 |
|
196 |
146 |
$11K |
| D1120 |
Prophylaxis - child |
335 |
335 |
$10K |
| D9110 |
|
573 |
572 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
159 |
102 |
$8K |
| D3320 |
|
29 |
26 |
$5K |
| D1351 |
Sealant - per tooth |
73 |
32 |
$4K |
| D0272 |
Bitewings - two radiographic images |
317 |
317 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
38 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
259 |
259 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
36 |
$2K |
| D2332 |
|
13 |
13 |
$1K |
| D2330 |
|
17 |
16 |
$922.64 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$808.20 |
| D1999 |
|
3,189 |
2,815 |
$0.00 |