| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
634 |
397 |
$306K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,370 |
1,516 |
$294K |
| D1110 |
Prophylaxis - adult |
3,808 |
3,751 |
$249K |
| D4341 |
|
1,489 |
698 |
$185K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
912 |
694 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
4,563 |
4,488 |
$135K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,938 |
4,867 |
$115K |
| D0210 |
Intraoral - complete series of radiographic images |
1,503 |
1,473 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
785 |
563 |
$71K |
| D0274 |
Bitewings - four radiographic images |
1,918 |
1,890 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
763 |
751 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
357 |
220 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
604 |
252 |
$48K |
| D0330 |
Panoramic radiographic image |
757 |
731 |
$48K |
| D2394 |
|
258 |
218 |
$45K |
| D1120 |
Prophylaxis - child |
883 |
866 |
$37K |
| D0180 |
|
551 |
531 |
$35K |
| D9944 |
|
68 |
68 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,972 |
1,913 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
562 |
541 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,107 |
1,052 |
$15K |
| D4910 |
|
193 |
193 |
$12K |
| D5214 |
|
12 |
12 |
$12K |
| D0272 |
Bitewings - two radiographic images |
275 |
262 |
$9K |
| D7250 |
|
44 |
27 |
$8K |
| D4355 |
|
26 |
25 |
$2K |
| D2950 |
|
23 |
18 |
$0.00 |