| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D6740 |
|
279 |
100 |
$234K |
| D6245 |
|
187 |
112 |
$157K |
| D4266 |
|
270 |
149 |
$137K |
| D4341 |
|
648 |
242 |
$116K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
742 |
317 |
$97K |
| D0330 |
Panoramic radiographic image |
1,279 |
1,272 |
$95K |
| D7953 |
|
327 |
169 |
$70K |
| D1110 |
Prophylaxis - adult |
1,194 |
1,193 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
681 |
340 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,259 |
1,256 |
$53K |
| D2950 |
|
318 |
200 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,198 |
1,194 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,580 |
1,576 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
792 |
786 |
$31K |
| D1310 |
|
839 |
839 |
$30K |
| D0431 |
|
568 |
568 |
$28K |
| D1330 |
|
840 |
840 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
833 |
833 |
$27K |
| D1120 |
Prophylaxis - child |
427 |
426 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
190 |
109 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
83 |
61 |
$9K |
| D2991 |
|
74 |
14 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
69 |
$8K |
| D4910 |
|
71 |
71 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
320 |
318 |
$5K |
| D2160 |
|
19 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$1K |