| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
2,149 |
1,059 |
$995K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,844 |
1,749 |
$760K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,777 |
1,881 |
$637K |
| D2740 |
Crown - porcelain/ceramic |
648 |
133 |
$548K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,183 |
1,517 |
$512K |
| D2950 |
|
2,504 |
1,050 |
$320K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,319 |
1,071 |
$242K |
| D0330 |
Panoramic radiographic image |
3,494 |
3,491 |
$177K |
| D2394 |
|
662 |
431 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,098 |
3,090 |
$120K |
| D0274 |
Bitewings - four radiographic images |
3,788 |
3,781 |
$109K |
| D1110 |
Prophylaxis - adult |
2,489 |
2,486 |
$109K |
| D0140 |
Limited oral evaluation - problem focused |
2,731 |
2,693 |
$92K |
| D5110 |
|
64 |
64 |
$50K |
| D2335 |
|
182 |
93 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
190 |
97 |
$30K |
| D2332 |
|
205 |
129 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,068 |
1,066 |
$23K |
| D2330 |
|
193 |
114 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,116 |
1,101 |
$13K |
| D1206 |
Topical application of fluoride varnish |
673 |
673 |
$11K |
| D1120 |
Prophylaxis - child |
350 |
350 |
$10K |
| D5120 |
|
12 |
12 |
$9K |
| D4342 |
|
99 |
29 |
$9K |
| D4910 |
|
36 |
36 |
$3K |
| D2331 |
|
23 |
15 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
76 |
$2K |
| D9110 |
|
36 |
36 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
20 |
$246.90 |