| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7953 |
|
549 |
187 |
$137K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
2,181 |
1,858 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
791 |
481 |
$78K |
| D1110 |
Prophylaxis - adult |
1,660 |
1,560 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,391 |
2,282 |
$66K |
| D1351 |
Sealant - per tooth |
2,945 |
397 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
976 |
924 |
$44K |
| D1120 |
Prophylaxis - child |
1,301 |
1,262 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,377 |
1,286 |
$39K |
| D0330 |
Panoramic radiographic image |
683 |
654 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
381 |
169 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,823 |
1,711 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
376 |
233 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,090 |
983 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,859 |
1,709 |
$27K |
| D1320 |
|
833 |
782 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,577 |
1,523 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,303 |
1,032 |
$16K |
| D1310 |
|
553 |
515 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
85 |
66 |
$13K |
| D7450 |
|
61 |
54 |
$12K |
| D7911 |
|
58 |
50 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
96 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
25 |
$4K |
| D4910 |
|
28 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
122 |
120 |
$2K |
| D1330 |
|
27 |
27 |
$338.00 |
| D4921 |
|
722 |
200 |
$0.00 |
| D9996 |
|
61 |
59 |
$0.00 |
| D1999 |
|
55 |
50 |
$0.00 |