| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
321 |
271 |
$99K |
| D1110 |
Prophylaxis - adult |
2,893 |
2,869 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
3,114 |
3,081 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
2,143 |
2,081 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
705 |
486 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,106 |
1,103 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
5,837 |
5,620 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
776 |
771 |
$22K |
| D1120 |
Prophylaxis - child |
950 |
946 |
$16K |
| D0274 |
Bitewings - four radiographic images |
1,781 |
1,748 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,168 |
3,874 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
323 |
214 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,280 |
1,278 |
$11K |
| D2950 |
|
183 |
168 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
199 |
136 |
$7K |
| D2954 |
|
154 |
140 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
142 |
95 |
$5K |
| D3221 |
|
191 |
178 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
12 |
$4K |
| D0272 |
Bitewings - two radiographic images |
752 |
747 |
$4K |
| D0330 |
Panoramic radiographic image |
156 |
154 |
$3K |
| D0270 |
|
306 |
302 |
$919.25 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$622.00 |
| D1330 |
|
134 |
99 |
$0.00 |