| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
703 |
479 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
7,228 |
7,127 |
$76K |
| D1110 |
Prophylaxis - adult |
5,428 |
5,351 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,054 |
4,963 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
1,582 |
1,544 |
$29K |
| D2954 |
|
642 |
446 |
$24K |
| D0274 |
Bitewings - four radiographic images |
3,086 |
3,053 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
6,680 |
6,383 |
$18K |
| D1120 |
Prophylaxis - child |
1,649 |
1,628 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,611 |
5,580 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
956 |
903 |
$10K |
| D1351 |
Sealant - per tooth |
378 |
41 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
45 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
28 |
$955.00 |
| D4341 |
|
27 |
13 |
$900.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
12 |
$832.00 |
| D1206 |
Topical application of fluoride varnish |
73 |
69 |
$765.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$300.00 |