| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,659 |
1,226 |
$755K |
| D1110 |
Prophylaxis - adult |
13,024 |
13,020 |
$533K |
| D0274 |
Bitewings - four radiographic images |
12,920 |
12,918 |
$272K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
898 |
772 |
$253K |
| D2954 |
|
2,157 |
1,636 |
$252K |
| D0120 |
Periodic oral evaluation - established patient |
10,948 |
10,944 |
$232K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,200 |
3,242 |
$230K |
| D0220 |
Intraoral - periapical first radiographic image |
18,052 |
17,422 |
$177K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,393 |
6,391 |
$140K |
| D3320 |
|
668 |
566 |
$134K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,094 |
2,353 |
$117K |
| D1120 |
Prophylaxis - child |
3,370 |
3,367 |
$107K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,434 |
1,092 |
$102K |
| D9990 |
|
4,287 |
3,863 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,080 |
13,965 |
$77K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
103 |
94 |
$56K |
| D0330 |
Panoramic radiographic image |
1,971 |
1,965 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,064 |
3,064 |
$34K |
| D9110 |
|
2,063 |
2,040 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
2,638 |
2,502 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
234 |
195 |
$15K |
| D0272 |
Bitewings - two radiographic images |
923 |
923 |
$12K |
| D1351 |
Sealant - per tooth |
180 |
121 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
847 |
840 |
$9K |
| D3310 |
|
30 |
25 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
95 |
$4K |
| D4341 |
|
46 |
29 |
$2K |
| D2331 |
|
29 |
27 |
$2K |
| D0270 |
|
16 |
16 |
$141.04 |
| D1999 |
|
130 |
124 |
$0.00 |
| D1330 |
|
18 |
18 |
$0.00 |