| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2330 |
|
2,570 |
947 |
$195K |
| D1110 |
Prophylaxis - adult |
1,500 |
1,497 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,946 |
1,946 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
2,210 |
2,201 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
2,022 |
2,019 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,413 |
809 |
$94K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
903 |
588 |
$72K |
| D9430 |
|
2,174 |
1,962 |
$69K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
525 |
244 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,239 |
3,229 |
$40K |
| D1120 |
Prophylaxis - child |
888 |
888 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,939 |
1,320 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
414 |
267 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,467 |
1,396 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
178 |
91 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
21 |
14 |
$10K |
| D0272 |
Bitewings - two radiographic images |
718 |
717 |
$8K |
| D0274 |
Bitewings - four radiographic images |
377 |
377 |
$8K |
| D5750 |
|
40 |
39 |
$8K |
| D2394 |
|
79 |
61 |
$7K |
| D4341 |
|
48 |
12 |
$3K |
| D4910 |
|
41 |
40 |
$3K |