| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
1,997 |
1,566 |
$106K |
| D2750 |
|
365 |
319 |
$95K |
| D1110 |
Prophylaxis - adult |
5,160 |
5,140 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
5,063 |
5,047 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,163 |
1,028 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,503 |
913 |
$67K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
238 |
230 |
$54K |
| D2335 |
|
945 |
574 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,745 |
4,643 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
1,592 |
1,591 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,229 |
778 |
$37K |
| D2330 |
|
854 |
440 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
853 |
529 |
$28K |
| D2954 |
|
437 |
381 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,050 |
1,049 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
4,872 |
4,781 |
$19K |
| D9110 |
|
1,833 |
1,728 |
$18K |
| D1351 |
Sealant - per tooth |
1,446 |
191 |
$15K |
| D7310 |
|
255 |
224 |
$15K |
| D1120 |
Prophylaxis - child |
859 |
857 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
858 |
734 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,087 |
1,086 |
$10K |
| D2160 |
|
202 |
149 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
104 |
79 |
$4K |
| D9430 |
|
514 |
478 |
$4K |
| D3320 |
|
15 |
15 |
$3K |
| D1353 |
|
164 |
26 |
$2K |
| D2161 |
|
31 |
27 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
16 |
$874.50 |