| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2721 |
|
296 |
199 |
$319K |
| D0330 |
Panoramic radiographic image |
3,217 |
3,176 |
$194K |
| D1110 |
Prophylaxis - adult |
2,957 |
2,934 |
$143K |
| D0140 |
Limited oral evaluation - problem focused |
4,104 |
3,978 |
$130K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,112 |
491 |
$102K |
| D0274 |
Bitewings - four radiographic images |
3,109 |
3,073 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,076 |
660 |
$85K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
714 |
412 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,116 |
2,088 |
$72K |
| D2950 |
|
365 |
267 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
5,476 |
5,183 |
$69K |
| D2722 |
|
63 |
44 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,833 |
2,555 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,660 |
1,648 |
$44K |
| D1206 |
Topical application of fluoride varnish |
1,670 |
1,663 |
$40K |
| D4341 |
|
107 |
39 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
165 |
123 |
$19K |
| D0270 |
|
1,893 |
1,857 |
$18K |
| D2335 |
|
131 |
85 |
$16K |
| D1330 |
|
875 |
864 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
93 |
64 |
$10K |
| D1120 |
Prophylaxis - child |
246 |
242 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
87 |
$4K |
| D1351 |
Sealant - per tooth |
112 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
139 |
136 |
$2K |
| D2332 |
|
18 |
15 |
$0.00 |