| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,437 |
1,101 |
$536K |
| D1110 |
Prophylaxis - adult |
13,937 |
13,935 |
$486K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,945 |
2,796 |
$237K |
| D0120 |
Periodic oral evaluation - established patient |
12,028 |
12,022 |
$229K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,093 |
2,478 |
$173K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,765 |
12,591 |
$161K |
| D0210 |
Intraoral - complete series of radiographic images |
7,346 |
7,249 |
$129K |
| D0220 |
Intraoral - periapical first radiographic image |
13,937 |
13,793 |
$121K |
| D0274 |
Bitewings - four radiographic images |
6,757 |
6,756 |
$109K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,557 |
1,241 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,935 |
3,935 |
$82K |
| D2952 |
|
675 |
586 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
971 |
700 |
$42K |
| D2330 |
|
856 |
486 |
$38K |
| D4341 |
|
556 |
273 |
$27K |
| D3320 |
|
142 |
130 |
$27K |
| D1120 |
Prophylaxis - child |
946 |
946 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
2,452 |
2,447 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,215 |
2,215 |
$23K |
| D2954 |
|
234 |
165 |
$21K |
| D2331 |
|
162 |
118 |
$11K |
| D1351 |
Sealant - per tooth |
182 |
81 |
$8K |
| D2394 |
|
106 |
86 |
$7K |
| D2335 |
|
73 |
68 |
$7K |
| D2332 |
|
76 |
64 |
$6K |
| D3310 |
|
26 |
24 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
152 |
152 |
$1K |
| D1999 |
|
4,882 |
4,156 |
$0.00 |
| D1330 |
|
26 |
26 |
$0.00 |