| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
719 |
605 |
$348K |
| D1110 |
Prophylaxis - adult |
1,975 |
1,975 |
$86K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
244 |
231 |
$75K |
| D2954 |
|
538 |
465 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,402 |
1,402 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,873 |
1,824 |
$20K |
| D0330 |
Panoramic radiographic image |
603 |
603 |
$18K |
| D0274 |
Bitewings - four radiographic images |
774 |
774 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
175 |
83 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
385 |
385 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
537 |
529 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
508 |
505 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
99 |
99 |
$1K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$385.92 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$110.63 |