| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
645 |
380 |
$272K |
| D1110 |
Prophylaxis - adult |
2,663 |
2,473 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,388 |
3,163 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,452 |
2,307 |
$55K |
| D0330 |
Panoramic radiographic image |
1,172 |
1,075 |
$40K |
| D7250 |
|
282 |
74 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
553 |
158 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,959 |
1,831 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,167 |
1,076 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
164 |
70 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,095 |
1,832 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
201 |
109 |
$15K |
| D1120 |
Prophylaxis - child |
365 |
347 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
559 |
511 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,909 |
1,074 |
$10K |
| D0274 |
Bitewings - four radiographic images |
415 |
389 |
$10K |
| D5110 |
|
13 |
12 |
$8K |
| D2160 |
|
53 |
26 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
30 |
$3K |
| D4355 |
|
31 |
26 |
$2K |
| D2140 |
|
23 |
14 |
$1K |
| D2950 |
|
43 |
38 |
$1K |
| D1206 |
Topical application of fluoride varnish |
45 |
42 |
$907.10 |