| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2712 |
|
77 |
64 |
$78K |
| D0350 |
|
744 |
741 |
$52K |
| D0330 |
Panoramic radiographic image |
568 |
563 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
479 |
225 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
276 |
112 |
$39K |
| D1110 |
Prophylaxis - adult |
638 |
632 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
744 |
740 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
786 |
717 |
$32K |
| D0274 |
Bitewings - four radiographic images |
717 |
713 |
$30K |
| D1206 |
Topical application of fluoride varnish |
874 |
865 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
193 |
113 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,222 |
1,166 |
$21K |
| D1330 |
|
591 |
582 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
414 |
410 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,118 |
905 |
$14K |
| D2950 |
|
64 |
53 |
$12K |
| D1120 |
Prophylaxis - child |
254 |
253 |
$11K |
| D9110 |
|
194 |
189 |
$9K |
| D9910 |
|
85 |
82 |
$3K |
| D1351 |
Sealant - per tooth |
82 |
14 |
$3K |
| D4910 |
|
12 |
12 |
$929.27 |
| D1310 |
|
30 |
29 |
$786.63 |
| D0460 |
|
30 |
28 |
$704.34 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$403.56 |
| D9985 |
|
68 |
47 |
$0.00 |