| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2722 |
|
472 |
277 |
$502K |
| D0330 |
Panoramic radiographic image |
3,019 |
2,979 |
$247K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,998 |
2,976 |
$132K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
866 |
488 |
$124K |
| D0274 |
Bitewings - four radiographic images |
2,811 |
2,789 |
$114K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
136 |
115 |
$96K |
| D2950 |
|
471 |
291 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
2,131 |
2,091 |
$88K |
| D4341 |
|
409 |
135 |
$87K |
| D1206 |
Topical application of fluoride varnish |
2,840 |
2,823 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
713 |
226 |
$76K |
| D1110 |
Prophylaxis - adult |
1,259 |
1,249 |
$75K |
| D1120 |
Prophylaxis - child |
1,696 |
1,682 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,052 |
2,128 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,725 |
1,708 |
$64K |
| D1330 |
|
1,778 |
1,761 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
655 |
239 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,145 |
3,020 |
$49K |
| D5225 |
|
25 |
25 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
379 |
154 |
$36K |
| D5226 |
|
16 |
16 |
$23K |
| D1351 |
Sealant - per tooth |
473 |
71 |
$16K |
| D0272 |
Bitewings - two radiographic images |
294 |
294 |
$11K |
| D3320 |
|
14 |
12 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
16 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
78 |
77 |
$2K |
| D0096 |
|
18 |
18 |
$62.84 |
| D9985 |
|
48 |
33 |
$0.00 |