| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
297 |
216 |
$170K |
| D0330 |
Panoramic radiographic image |
2,538 |
2,526 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,722 |
782 |
$99K |
| D1110 |
Prophylaxis - adult |
2,325 |
2,314 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,054 |
619 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,001 |
2,981 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,457 |
729 |
$74K |
| D2950 |
|
335 |
252 |
$48K |
| D1120 |
Prophylaxis - child |
719 |
718 |
$28K |
| D1351 |
Sealant - per tooth |
849 |
113 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
912 |
908 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
641 |
636 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
849 |
848 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,244 |
1,235 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
474 |
466 |
$17K |
| D0274 |
Bitewings - four radiographic images |
459 |
458 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
107 |
88 |
$12K |
| D3320 |
|
27 |
24 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
862 |
748 |
$7K |
| D4341 |
|
72 |
29 |
$7K |
| D0180 |
|
133 |
133 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
16 |
$3K |
| D4355 |
|
15 |
15 |
$1K |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$704.79 |