| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,044 |
818 |
$724K |
| D1110 |
Prophylaxis - adult |
7,040 |
6,901 |
$304K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,356 |
3,155 |
$302K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,440 |
1,370 |
$233K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
300 |
281 |
$184K |
| D0210 |
Intraoral - complete series of radiographic images |
3,654 |
3,612 |
$162K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,444 |
2,198 |
$153K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,604 |
1,152 |
$146K |
| D2954 |
|
919 |
783 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
8,312 |
8,149 |
$132K |
| D0140 |
Limited oral evaluation - problem focused |
4,550 |
4,286 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,311 |
4,204 |
$111K |
| D1120 |
Prophylaxis - child |
3,480 |
3,443 |
$101K |
| D3320 |
|
141 |
126 |
$67K |
| D0274 |
Bitewings - four radiographic images |
4,403 |
4,332 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
8,457 |
8,071 |
$50K |
| D1206 |
Topical application of fluoride varnish |
2,889 |
2,829 |
$46K |
| D2335 |
|
432 |
291 |
$46K |
| D4341 |
|
439 |
181 |
$41K |
| D8670 |
Periodic orthodontic treatment visit |
892 |
808 |
$34K |
| D2332 |
|
371 |
268 |
$31K |
| D2331 |
|
414 |
310 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
346 |
175 |
$18K |
| D1351 |
Sealant - per tooth |
732 |
129 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,364 |
5,168 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,246 |
1,246 |
$13K |
| D3310 |
|
35 |
29 |
$11K |
| D2330 |
|
189 |
131 |
$10K |
| D4910 |
|
179 |
172 |
$10K |
| D0330 |
Panoramic radiographic image |
221 |
221 |
$8K |
| D2950 |
|
82 |
74 |
$7K |
| D0272 |
Bitewings - two radiographic images |
406 |
406 |
$5K |
| D0350 |
|
847 |
847 |
$851.00 |
| D9310 |
|
27 |
26 |
$407.00 |
| D0602 |
|
12 |
12 |
$120.00 |
| D0270 |
|
12 |
12 |
$36.00 |
| D1999 |
|
4,048 |
3,625 |
$0.00 |