| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
2,054 |
1,481 |
$448K |
| D2952 |
|
1,245 |
949 |
$76K |
| D1110 |
Prophylaxis - adult |
4,716 |
4,703 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
4,636 |
4,620 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
2,922 |
2,901 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,849 |
2,836 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
2,854 |
2,811 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
7,752 |
6,579 |
$24K |
| D0274 |
Bitewings - four radiographic images |
2,014 |
2,003 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,554 |
2,464 |
$9K |
| D1120 |
Prophylaxis - child |
731 |
731 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
226 |
89 |
$6K |
| D3320 |
|
30 |
24 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
115 |
80 |
$4K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
341 |
341 |
$2K |
| D2954 |
|
42 |
37 |
$1K |
| D1351 |
Sealant - per tooth |
110 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
70 |
70 |
$703.50 |
| D4341 |
|
22 |
13 |
$552.50 |
| D0602 |
|
13 |
13 |
$110.00 |
| D2920 |
|
20 |
12 |
$103.00 |