| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
691 |
652 |
$288K |
| D1110 |
Prophylaxis - adult |
5,626 |
5,624 |
$213K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,794 |
1,518 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
5,914 |
5,913 |
$119K |
| D0274 |
Bitewings - four radiographic images |
5,184 |
5,183 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
8,151 |
8,124 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,233 |
7,229 |
$49K |
| D2952 |
|
501 |
471 |
$48K |
| D2140 |
|
921 |
752 |
$43K |
| D1120 |
Prophylaxis - child |
1,208 |
1,208 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,676 |
1,676 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,131 |
2,131 |
$23K |
| D9110 |
|
1,376 |
1,370 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
2,472 |
2,456 |
$20K |
| D2160 |
|
268 |
243 |
$19K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
57 |
56 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,023 |
1,023 |
$12K |
| D1351 |
Sealant - per tooth |
170 |
100 |
$11K |
| D2335 |
|
17 |
14 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
36 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
24 |
$1K |
| D0270 |
|
127 |
127 |
$1K |
| D2161 |
|
13 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
67 |
67 |
$710.65 |
| D2920 |
|
25 |
25 |
$699.66 |
| D9920 |
|
13 |
13 |
$160.74 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$159.97 |