| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,904 |
1,351 |
$918K |
| D1110 |
Prophylaxis - adult |
4,195 |
4,108 |
$272K |
| D4341 |
|
2,121 |
697 |
$256K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,441 |
900 |
$201K |
| D0330 |
Panoramic radiographic image |
3,144 |
3,052 |
$197K |
| D0140 |
Limited oral evaluation - problem focused |
4,232 |
3,790 |
$182K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,313 |
769 |
$159K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,948 |
1,896 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
4,050 |
3,942 |
$119K |
| D0274 |
Bitewings - four radiographic images |
3,244 |
3,166 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,886 |
4,750 |
$114K |
| D2954 |
|
730 |
544 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,019 |
3,304 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
586 |
306 |
$56K |
| D4342 |
|
558 |
166 |
$38K |
| D9110 |
|
546 |
528 |
$37K |
| D5214 |
|
37 |
37 |
$31K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
45 |
38 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,251 |
960 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
199 |
82 |
$17K |
| D5213 |
|
14 |
14 |
$14K |
| D3320 |
|
30 |
26 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
64 |
42 |
$10K |
| D7250 |
|
38 |
24 |
$9K |
| D0460 |
|
331 |
290 |
$8K |
| D1120 |
Prophylaxis - child |
172 |
171 |
$7K |
| D4910 |
|
28 |
25 |
$2K |
| D1206 |
Topical application of fluoride varnish |
59 |
58 |
$1K |
| D0350 |
|
24 |
24 |
$974.04 |