| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
933 |
682 |
$519K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,637 |
1,204 |
$284K |
| D0140 |
Limited oral evaluation - problem focused |
3,509 |
3,430 |
$141K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
280 |
246 |
$134K |
| D1110 |
Prophylaxis - adult |
2,869 |
2,859 |
$128K |
| D0210 |
Intraoral - complete series of radiographic images |
1,481 |
1,480 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,806 |
2,795 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,514 |
2,502 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,243 |
2,235 |
$54K |
| D0330 |
Panoramic radiographic image |
2,544 |
2,522 |
$49K |
| D1120 |
Prophylaxis - child |
786 |
781 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
648 |
453 |
$31K |
| D1206 |
Topical application of fluoride varnish |
964 |
959 |
$29K |
| D3320 |
|
80 |
63 |
$29K |
| D2954 |
|
185 |
147 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,953 |
1,941 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,680 |
2,613 |
$11K |
| D2950 |
|
157 |
129 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
198 |
142 |
$8K |
| D1351 |
Sealant - per tooth |
229 |
33 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
53 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
69 |
32 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
943 |
464 |
$1K |
| D0603 |
|
88 |
87 |
$710.00 |
| D0601 |
|
31 |
30 |
$205.00 |
| D0272 |
Bitewings - two radiographic images |
40 |
39 |
$172.50 |