| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
895 |
516 |
$344K |
| D1110 |
Prophylaxis - adult |
2,935 |
2,880 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
3,377 |
3,325 |
$102K |
| D1206 |
Topical application of fluoride varnish |
2,346 |
2,302 |
$58K |
| D2950 |
|
649 |
387 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,791 |
1,748 |
$41K |
| D0330 |
Panoramic radiographic image |
842 |
823 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
601 |
580 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
219 |
90 |
$27K |
| D1120 |
Prophylaxis - child |
568 |
560 |
$25K |
| D3320 |
|
28 |
25 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,343 |
1,281 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
93 |
66 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
97 |
61 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
180 |
172 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
402 |
393 |
$5K |
| D0272 |
Bitewings - two radiographic images |
255 |
254 |
$4K |
| D1330 |
|
215 |
214 |
$1K |