| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2991 |
|
9,301 |
1,388 |
$1.06M |
| D1354 |
|
21,655 |
3,562 |
$789K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,374 |
1,294 |
$370K |
| D0330 |
Panoramic radiographic image |
4,433 |
4,223 |
$368K |
| D1110 |
Prophylaxis - adult |
4,972 |
4,859 |
$327K |
| D0274 |
Bitewings - four radiographic images |
6,052 |
5,816 |
$252K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,033 |
1,670 |
$239K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,330 |
1,475 |
$235K |
| D0140 |
Limited oral evaluation - problem focused |
5,566 |
5,150 |
$195K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,649 |
3,559 |
$169K |
| D1330 |
|
5,999 |
5,878 |
$135K |
| D1206 |
Topical application of fluoride varnish |
3,902 |
3,814 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,200 |
6,675 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
7,959 |
7,578 |
$130K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
869 |
650 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
2,544 |
2,518 |
$95K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
704 |
490 |
$78K |
| D2331 |
|
568 |
357 |
$66K |
| D9110 |
|
1,269 |
1,199 |
$58K |
| D2332 |
|
377 |
225 |
$56K |
| D1120 |
Prophylaxis - child |
1,129 |
1,123 |
$53K |
| D2335 |
|
330 |
239 |
$51K |
| D2160 |
|
262 |
205 |
$35K |
| D2140 |
|
383 |
257 |
$33K |
| D2330 |
|
336 |
226 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
105 |
87 |
$16K |
| D0240 |
|
241 |
125 |
$10K |
| D1310 |
|
317 |
317 |
$9K |
| D3320 |
|
13 |
13 |
$7K |
| D2394 |
|
42 |
40 |
$6K |
| D1351 |
Sealant - per tooth |
130 |
35 |
$5K |
| D2161 |
|
28 |
26 |
$5K |
| D1355 |
|
56 |
15 |
$3K |
| D7111 |
|
19 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
60 |
56 |
$2K |
| D2940 |
|
18 |
12 |
$992.56 |