| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
293 |
244 |
$196K |
| D1110 |
Prophylaxis - adult |
3,382 |
3,363 |
$163K |
| D0120 |
Periodic oral evaluation - established patient |
3,854 |
3,832 |
$106K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
782 |
419 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
1,015 |
1,014 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,261 |
1,258 |
$40K |
| D1120 |
Prophylaxis - child |
1,045 |
1,037 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
445 |
323 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,377 |
1,371 |
$28K |
| D2950 |
|
216 |
177 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,287 |
1,281 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
238 |
166 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
345 |
253 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,557 |
1,522 |
$15K |
| D0330 |
Panoramic radiographic image |
251 |
249 |
$8K |
| D0272 |
Bitewings - two radiographic images |
497 |
497 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
850 |
533 |
$6K |
| D2335 |
|
41 |
25 |
$5K |
| D1351 |
Sealant - per tooth |
222 |
42 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
183 |
180 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
12 |
$3K |
| D2394 |
|
19 |
15 |
$2K |
| D1206 |
Topical application of fluoride varnish |
67 |
67 |
$1K |