| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
230 |
147 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
357 |
345 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
153 |
59 |
$14K |
| D1110 |
Prophylaxis - adult |
201 |
196 |
$13K |
| D0330 |
Panoramic radiographic image |
286 |
275 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
14 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
51 |
27 |
$7K |
| D2950 |
|
70 |
51 |
$6K |
| D0274 |
Bitewings - four radiographic images |
251 |
244 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
427 |
378 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
127 |
127 |
$4K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
20 |
15 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
74 |
64 |
$3K |
| D1206 |
Topical application of fluoride varnish |
106 |
105 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
130 |
124 |
$2K |
| D9222 |
|
20 |
15 |
$1K |
| D1120 |
Prophylaxis - child |
27 |
26 |
$1K |