| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2722 |
|
267 |
151 |
$278K |
| D0330 |
Panoramic radiographic image |
3,299 |
3,238 |
$236K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,302 |
4,254 |
$173K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,049 |
368 |
$160K |
| D0274 |
Bitewings - four radiographic images |
3,945 |
3,886 |
$148K |
| D4341 |
|
692 |
265 |
$142K |
| D1110 |
Prophylaxis - adult |
1,347 |
1,332 |
$78K |
| D2950 |
|
363 |
250 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,978 |
2,995 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,895 |
1,874 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
3,590 |
3,512 |
$53K |
| D6750 |
|
48 |
16 |
$51K |
| D1120 |
Prophylaxis - child |
1,168 |
1,159 |
$48K |
| D2740 |
Crown - porcelain/ceramic |
72 |
45 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,158 |
1,128 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,279 |
1,265 |
$42K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
63 |
54 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
350 |
210 |
$38K |
| D6240 |
|
27 |
15 |
$28K |
| D1351 |
Sealant - per tooth |
782 |
124 |
$22K |
| D1330 |
|
646 |
642 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
138 |
78 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
119 |
59 |
$13K |
| D5226 |
|
14 |
13 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
62 |
$11K |
| D3320 |
|
18 |
16 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
88 |
85 |
$7K |
| D7250 |
|
33 |
13 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
46 |
$6K |
| D0272 |
Bitewings - two radiographic images |
137 |
137 |
$4K |
| D2160 |
|
21 |
15 |
$3K |
| D0270 |
|
37 |
37 |
$312.72 |
| D1999 |
|
22 |
20 |
$0.00 |