| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,059 |
783 |
$348K |
| D0120 |
Periodic oral evaluation - established patient |
7,585 |
7,149 |
$194K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,219 |
1,719 |
$173K |
| D1110 |
Prophylaxis - adult |
4,167 |
3,944 |
$160K |
| D2740 |
Crown - porcelain/ceramic |
468 |
405 |
$152K |
| D0274 |
Bitewings - four radiographic images |
8,687 |
8,207 |
$126K |
| D1120 |
Prophylaxis - child |
3,130 |
2,961 |
$118K |
| D2950 |
|
1,804 |
1,458 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,114 |
787 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
847 |
686 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
3,856 |
3,570 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,292 |
2,191 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,827 |
1,715 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,375 |
4,053 |
$23K |
| D3310 |
|
86 |
57 |
$18K |
| D0330 |
Panoramic radiographic image |
497 |
487 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
121 |
93 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,188 |
2,050 |
$8K |
| D2332 |
|
56 |
40 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
39 |
$2K |
| D0272 |
Bitewings - two radiographic images |
142 |
129 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
39 |
$617.00 |