| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
654 |
496 |
$497K |
| D1110 |
Prophylaxis - adult |
5,768 |
5,765 |
$357K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,327 |
1,246 |
$317K |
| D0120 |
Periodic oral evaluation - established patient |
6,130 |
6,127 |
$191K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,517 |
1,336 |
$169K |
| D9310 |
|
1,702 |
1,700 |
$117K |
| D0274 |
Bitewings - four radiographic images |
3,462 |
3,462 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
6,546 |
6,360 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,163 |
1,006 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
710 |
638 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,379 |
4,352 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
2,500 |
2,429 |
$37K |
| D1120 |
Prophylaxis - child |
687 |
687 |
$32K |
| D2954 |
|
137 |
110 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
1,331 |
1,301 |
$20K |
| D0330 |
Panoramic radiographic image |
490 |
490 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,153 |
1,153 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
344 |
344 |
$11K |
| D9243 |
|
33 |
32 |
$8K |
| D4211 |
|
85 |
80 |
$6K |
| D2331 |
|
33 |
31 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
39 |
$4K |
| D2332 |
|
27 |
26 |
$4K |
| D0272 |
Bitewings - two radiographic images |
186 |
186 |
$3K |
| D2330 |
|
26 |
26 |
$3K |
| D9239 |
|
33 |
32 |
$3K |
| D2394 |
|
13 |
12 |
$2K |
| D9110 |
|
38 |
38 |
$1K |
| D0270 |
|
24 |
24 |
$369.60 |
| D3120 |
|
14 |
13 |
$0.00 |
| D1999 |
|
614 |
518 |
$0.00 |
| D0180 |
|
71 |
71 |
$0.00 |