| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
1,486 |
1,134 |
$633K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,592 |
2,366 |
$254K |
| D1110 |
Prophylaxis - adult |
6,345 |
6,292 |
$190K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,615 |
2,045 |
$128K |
| D0140 |
Limited oral evaluation - problem focused |
5,589 |
5,505 |
$127K |
| D2954 |
|
1,528 |
1,173 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
7,295 |
7,214 |
$108K |
| D1206 |
Topical application of fluoride varnish |
4,858 |
4,807 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
2,133 |
2,125 |
$106K |
| D1120 |
Prophylaxis - child |
3,486 |
3,460 |
$95K |
| D1351 |
Sealant - per tooth |
6,150 |
988 |
$92K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
311 |
251 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,540 |
5,488 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,047 |
5,002 |
$75K |
| D0330 |
Panoramic radiographic image |
5,616 |
5,557 |
$52K |
| D0274 |
Bitewings - four radiographic images |
6,828 |
6,739 |
$32K |
| D7240 |
Removal of impacted tooth - completely bony |
215 |
102 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
583 |
398 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
983 |
644 |
$24K |
| D7230 |
|
216 |
135 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
5,486 |
5,301 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
265 |
118 |
$8K |
| D0603 |
|
1,156 |
1,145 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,434 |
2,329 |
$5K |
| D0602 |
|
827 |
819 |
$5K |
| D2331 |
|
144 |
98 |
$5K |
| D4910 |
|
65 |
64 |
$4K |
| D0272 |
Bitewings - two radiographic images |
579 |
574 |
$2K |
| D9920 |
|
97 |
92 |
$548.00 |
| D0601 |
|
15 |
15 |
$40.00 |