| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
283 |
195 |
$170K |
| D0330 |
Panoramic radiographic image |
2,447 |
2,242 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
2,032 |
1,798 |
$20K |
| D2954 |
|
183 |
126 |
$20K |
| D1110 |
Prophylaxis - adult |
2,681 |
2,500 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,314 |
2,180 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
602 |
584 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
355 |
132 |
$12K |
| D1206 |
Topical application of fluoride varnish |
2,034 |
1,929 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
48 |
28 |
$10K |
| D1120 |
Prophylaxis - child |
1,667 |
1,584 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,513 |
2,341 |
$8K |
| D1351 |
Sealant - per tooth |
2,094 |
417 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
224 |
137 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,121 |
448 |
$3K |
| D4341 |
|
36 |
14 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,401 |
1,261 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
663 |
597 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
14 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
3,428 |
3,235 |
$707.50 |
| D0601 |
|
12 |
12 |
$120.00 |
| D0603 |
|
970 |
900 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |
| D9310 |
|
14 |
14 |
$0.00 |