| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2990 |
|
1,210 |
290 |
$152K |
| D0330 |
Panoramic radiographic image |
1,358 |
1,220 |
$79K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
387 |
156 |
$65K |
| D2332 |
|
559 |
181 |
$63K |
| D1351 |
Sealant - per tooth |
2,105 |
319 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,376 |
1,244 |
$52K |
| D1110 |
Prophylaxis - adult |
1,009 |
927 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,441 |
1,293 |
$45K |
| D1354 |
|
516 |
125 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
469 |
172 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,680 |
1,514 |
$38K |
| D4342 |
|
368 |
83 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,303 |
1,195 |
$27K |
| D1120 |
Prophylaxis - child |
655 |
596 |
$19K |
| D4346 |
|
93 |
89 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,505 |
1,332 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,481 |
1,296 |
$16K |
| D7311 |
|
125 |
72 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
270 |
220 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
119 |
39 |
$7K |
| D4341 |
|
45 |
13 |
$7K |
| D7310 |
|
26 |
12 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
57 |
54 |
$912.60 |
| D1320 |
|
22 |
14 |
$434.20 |