| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
728 |
619 |
$294K |
| D1110 |
Prophylaxis - adult |
4,452 |
4,442 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,719 |
1,211 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
5,139 |
5,127 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,947 |
2,939 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
2,374 |
2,303 |
$57K |
| D0330 |
Panoramic radiographic image |
1,744 |
1,739 |
$51K |
| D1120 |
Prophylaxis - child |
1,650 |
1,648 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,865 |
1,859 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
4,345 |
3,976 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,600 |
1,600 |
$24K |
| D2954 |
|
208 |
175 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
343 |
257 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
161 |
125 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
115 |
50 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,255 |
1,183 |
$5K |
| D0272 |
Bitewings - two radiographic images |
301 |
300 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
24 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
13 |
$770.00 |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
19 |
$480.00 |
| D2950 |
|
15 |
12 |
$275.00 |
| D1999 |
|
324 |
270 |
$0.00 |