| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
556 |
319 |
$243K |
| D1110 |
Prophylaxis - adult |
3,588 |
3,460 |
$238K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,566 |
663 |
$214K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,549 |
1,083 |
$211K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,577 |
720 |
$151K |
| D0140 |
Limited oral evaluation - problem focused |
3,589 |
3,272 |
$149K |
| D0330 |
Panoramic radiographic image |
2,302 |
2,169 |
$147K |
| D4341 |
|
1,043 |
360 |
$138K |
| D6010 |
|
224 |
89 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
3,813 |
3,679 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,347 |
595 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,434 |
1,381 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,881 |
2,794 |
$69K |
| D9310 |
|
693 |
652 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
470 |
264 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,597 |
1,523 |
$55K |
| D1120 |
Prophylaxis - child |
1,009 |
982 |
$44K |
| D7250 |
|
146 |
84 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,315 |
2,105 |
$33K |
| D1351 |
Sealant - per tooth |
842 |
177 |
$29K |
| D0272 |
Bitewings - two radiographic images |
793 |
760 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,212 |
1,122 |
$25K |
| D4910 |
|
349 |
335 |
$23K |
| D2394 |
|
161 |
89 |
$23K |
| D1206 |
Topical application of fluoride varnish |
774 |
755 |
$21K |
| D4355 |
|
221 |
212 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
246 |
243 |
$17K |
| D9110 |
|
243 |
228 |
$16K |
| D2335 |
|
117 |
71 |
$16K |
| D4210 |
|
56 |
13 |
$15K |
| D2332 |
|
103 |
74 |
$14K |
| D6056 |
|
35 |
12 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
209 |
198 |
$9K |
| D0340 |
|
45 |
43 |
$4K |
| D0350 |
|
76 |
73 |
$4K |
| D2330 |
|
38 |
24 |
$3K |
| D0270 |
|
12 |
12 |
$242.00 |