| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
587 |
459 |
$264K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,862 |
740 |
$225K |
| D1110 |
Prophylaxis - adult |
2,730 |
2,672 |
$111K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
260 |
241 |
$98K |
| D9310 |
|
1,787 |
1,752 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
647 |
389 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,713 |
1,669 |
$51K |
| D2954 |
|
427 |
323 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,171 |
2,128 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,161 |
1,116 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,311 |
2,249 |
$29K |
| D0330 |
Panoramic radiographic image |
566 |
556 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
719 |
700 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
257 |
165 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
385 |
347 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,263 |
759 |
$12K |
| D1206 |
Topical application of fluoride varnish |
104 |
104 |
$2K |
| D0270 |
|
87 |
86 |
$1K |
| D0367 |
|
454 |
452 |
$0.00 |
| D0351 |
|
14 |
14 |
$0.00 |
| D0383 |
|
258 |
241 |
$0.00 |