| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
426 |
276 |
$248K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,479 |
2,417 |
$241K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,777 |
8,487 |
$237K |
| D1110 |
Prophylaxis - adult |
5,207 |
5,041 |
$235K |
| D0210 |
Intraoral - complete series of radiographic images |
3,540 |
3,436 |
$202K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,194 |
1,546 |
$136K |
| D0330 |
Panoramic radiographic image |
2,431 |
2,376 |
$99K |
| D4341 |
|
1,339 |
531 |
$91K |
| D0274 |
Bitewings - four radiographic images |
4,039 |
3,904 |
$90K |
| D0140 |
Limited oral evaluation - problem focused |
2,667 |
2,408 |
$77K |
| D1120 |
Prophylaxis - child |
1,456 |
1,382 |
$67K |
| D5130 |
|
91 |
91 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,313 |
3,173 |
$50K |
| D5222 |
|
64 |
64 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
672 |
444 |
$29K |
| D2332 |
|
382 |
242 |
$25K |
| D5140 |
|
40 |
40 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
3,021 |
2,834 |
$21K |
| D5110 |
|
27 |
27 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
168 |
53 |
$16K |
| D1351 |
Sealant - per tooth |
932 |
155 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
245 |
244 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,217 |
712 |
$6K |
| D2335 |
|
59 |
24 |
$4K |
| D2330 |
|
27 |
15 |
$1K |
| D0272 |
Bitewings - two radiographic images |
22 |
13 |
$187.81 |