| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
920 |
745 |
$541K |
| D1110 |
Prophylaxis - adult |
6,053 |
5,981 |
$282K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,924 |
2,314 |
$210K |
| D0120 |
Periodic oral evaluation - established patient |
5,288 |
5,226 |
$148K |
| D0210 |
Intraoral - complete series of radiographic images |
2,994 |
2,963 |
$146K |
| D0140 |
Limited oral evaluation - problem focused |
2,755 |
2,631 |
$122K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,484 |
878 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,669 |
3,628 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,433 |
2,409 |
$65K |
| D2954 |
|
571 |
477 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
496 |
302 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
909 |
598 |
$36K |
| D1206 |
Topical application of fluoride varnish |
967 |
956 |
$30K |
| D2394 |
|
350 |
167 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,990 |
1,964 |
$25K |
| D1120 |
Prophylaxis - child |
518 |
517 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,472 |
3,150 |
$15K |
| D4355 |
|
119 |
119 |
$14K |
| D9110 |
|
397 |
390 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$7K |
| D3320 |
|
13 |
12 |
$5K |
| D2335 |
|
34 |
14 |
$3K |
| D2330 |
|
28 |
12 |
$1K |
| D0602 |
|
110 |
109 |
$1K |
| D2331 |
|
19 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
81 |
78 |
$321.00 |
| D0603 |
|
14 |
14 |
$140.00 |