| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
946 |
654 |
$465K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
823 |
494 |
$114K |
| D0330 |
Panoramic radiographic image |
1,738 |
1,689 |
$110K |
| D1110 |
Prophylaxis - adult |
1,610 |
1,572 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
2,262 |
2,056 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
766 |
429 |
$95K |
| D4341 |
|
702 |
236 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,134 |
1,106 |
$73K |
| D0274 |
Bitewings - four radiographic images |
1,676 |
1,640 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
563 |
285 |
$53K |
| D2954 |
|
589 |
435 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,930 |
1,889 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,214 |
1,185 |
$36K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
59 |
52 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
1,947 |
1,731 |
$29K |
| D3320 |
|
61 |
53 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
916 |
658 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
26 |
$6K |
| D0460 |
|
174 |
157 |
$5K |
| D1120 |
Prophylaxis - child |
45 |
45 |
$2K |
| D9110 |
|
19 |
17 |
$1K |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$435.00 |