| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
740 |
572 |
$429K |
| D1110 |
Prophylaxis - adult |
3,894 |
3,819 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
3,566 |
3,510 |
$94K |
| D0140 |
Limited oral evaluation - problem focused |
1,815 |
1,722 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,058 |
639 |
$56K |
| D1206 |
Topical application of fluoride varnish |
1,775 |
1,751 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,110 |
2,045 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,756 |
1,721 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,564 |
3,897 |
$45K |
| D1120 |
Prophylaxis - child |
924 |
907 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
823 |
805 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
785 |
483 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
5,559 |
5,069 |
$29K |
| D2954 |
|
268 |
226 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,928 |
1,903 |
$24K |
| D0330 |
Panoramic radiographic image |
537 |
518 |
$21K |
| D9110 |
|
645 |
601 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
20 |
16 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
129 |
90 |
$8K |
| D4341 |
|
40 |
14 |
$3K |
| D2330 |
|
46 |
26 |
$3K |
| D1351 |
Sealant - per tooth |
93 |
14 |
$2K |
| D2332 |
|
23 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
145 |
145 |
$1K |
| D2331 |
|
19 |
12 |
$1K |
| D0601 |
|
72 |
69 |
$650.00 |
| D0603 |
|
37 |
37 |
$360.00 |
| D0350 |
|
170 |
170 |
$302.50 |
| D1999 |
|
1,857 |
1,326 |
$0.00 |