| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
2,904 |
2,054 |
$1.58M |
| D1110 |
Prophylaxis - adult |
11,160 |
10,851 |
$535K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,014 |
2,129 |
$436K |
| D1351 |
Sealant - per tooth |
17,895 |
2,936 |
$380K |
| D0120 |
Periodic oral evaluation - established patient |
13,739 |
13,348 |
$367K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
688 |
565 |
$338K |
| D1120 |
Prophylaxis - child |
7,406 |
7,180 |
$334K |
| D0140 |
Limited oral evaluation - problem focused |
7,671 |
7,075 |
$333K |
| D0210 |
Intraoral - complete series of radiographic images |
6,009 |
5,926 |
$296K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,479 |
2,984 |
$285K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,005 |
10,689 |
$265K |
| D1206 |
Topical application of fluoride varnish |
7,205 |
6,964 |
$241K |
| D2954 |
|
1,881 |
1,436 |
$180K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,869 |
6,692 |
$180K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,750 |
649 |
$92K |
| D0330 |
Panoramic radiographic image |
5,254 |
4,938 |
$86K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,196 |
780 |
$75K |
| D0274 |
Bitewings - four radiographic images |
7,965 |
7,610 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,273 |
749 |
$53K |
| D7240 |
Removal of impacted tooth - completely bony |
181 |
63 |
$42K |
| D0603 |
|
5,117 |
4,930 |
$42K |
| D4355 |
|
233 |
216 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
5,695 |
5,394 |
$26K |
| D3320 |
|
63 |
53 |
$23K |
| D4341 |
|
247 |
88 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
724 |
629 |
$17K |
| D4910 |
|
170 |
161 |
$15K |
| D9920 |
|
560 |
527 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,073 |
1,045 |
$9K |
| D2950 |
|
202 |
126 |
$9K |
| D7230 |
|
29 |
15 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,639 |
1,328 |
$4K |
| D2332 |
|
44 |
27 |
$3K |
| D9310 |
|
87 |
86 |
$2K |
| D0602 |
|
78 |
78 |
$780.00 |
| D1353 |
|
119 |
13 |
$0.00 |