| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2991 |
|
15,527 |
1,683 |
$1.82M |
| D0330 |
Panoramic radiographic image |
2,942 |
2,923 |
$256K |
| D1354 |
|
5,836 |
952 |
$210K |
| D1110 |
Prophylaxis - adult |
2,383 |
2,365 |
$158K |
| D0140 |
Limited oral evaluation - problem focused |
3,107 |
2,970 |
$137K |
| D0274 |
Bitewings - four radiographic images |
3,024 |
3,009 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,438 |
2,424 |
$121K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,076 |
379 |
$120K |
| D1330 |
|
3,325 |
3,299 |
$94K |
| D1206 |
Topical application of fluoride varnish |
2,431 |
2,412 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
4,224 |
4,151 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,702 |
3,723 |
$75K |
| D1120 |
Prophylaxis - child |
966 |
959 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
693 |
691 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
205 |
150 |
$20K |
| D4341 |
|
85 |
38 |
$19K |
| D0350 |
|
1,082 |
1,069 |
$18K |
| D4355 |
|
266 |
265 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
137 |
$16K |
| D1351 |
Sealant - per tooth |
362 |
89 |
$15K |
| D0272 |
Bitewings - two radiographic images |
331 |
330 |
$13K |
| D0240 |
|
291 |
148 |
$12K |
| D9110 |
|
172 |
162 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
52 |
39 |
$6K |
| D1310 |
|
122 |
122 |
$3K |
| D1355 |
|
60 |
25 |
$3K |
| D2330 |
|
28 |
16 |
$3K |
| D2140 |
|
23 |
16 |
$2K |
| D9996 |
|
17 |
17 |
$0.00 |