| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
619 |
472 |
$275K |
| D1110 |
Prophylaxis - adult |
8,793 |
8,720 |
$231K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,800 |
2,268 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
7,837 |
7,775 |
$176K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,015 |
1,966 |
$162K |
| D0140 |
Limited oral evaluation - problem focused |
4,428 |
4,284 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,105 |
4,057 |
$90K |
| D0330 |
Panoramic radiographic image |
3,493 |
3,444 |
$80K |
| D1120 |
Prophylaxis - child |
2,824 |
2,790 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
2,290 |
2,290 |
$78K |
| D0274 |
Bitewings - four radiographic images |
5,354 |
5,286 |
$60K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
948 |
568 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
751 |
546 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
8,928 |
8,629 |
$36K |
| D5214 |
|
75 |
75 |
$35K |
| D1351 |
Sealant - per tooth |
2,099 |
295 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,256 |
2,239 |
$27K |
| D2954 |
|
330 |
260 |
$26K |
| D5213 |
|
57 |
57 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,132 |
6,752 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
532 |
269 |
$21K |
| D2740 |
Crown - porcelain/ceramic |
32 |
25 |
$12K |
| D5110 |
|
27 |
27 |
$9K |
| D2335 |
|
153 |
86 |
$9K |
| D7250 |
|
178 |
114 |
$9K |
| D1206 |
Topical application of fluoride varnish |
460 |
446 |
$8K |
| D0601 |
|
802 |
777 |
$6K |
| D5120 |
|
14 |
14 |
$6K |
| D3320 |
|
13 |
13 |
$4K |
| D2332 |
|
77 |
54 |
$4K |
| D2330 |
|
84 |
47 |
$3K |
| D9920 |
|
135 |
131 |
$2K |
| D2331 |
|
38 |
27 |
$1K |
| D4341 |
|
27 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
90 |
88 |
$542.90 |
| D9110 |
|
12 |
12 |
$90.00 |
| D1999 |
|
164 |
155 |
$0.00 |
| D1330 |
|
48 |
47 |
$0.00 |