| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,285 |
1,070 |
$498K |
| D1110 |
Prophylaxis - adult |
12,000 |
11,994 |
$431K |
| D0120 |
Periodic oral evaluation - established patient |
10,488 |
10,483 |
$197K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,344 |
2,451 |
$189K |
| D0274 |
Bitewings - four radiographic images |
9,956 |
9,953 |
$179K |
| D0210 |
Intraoral - complete series of radiographic images |
3,955 |
3,935 |
$127K |
| D0220 |
Intraoral - periapical first radiographic image |
12,569 |
12,458 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,185 |
4,182 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,830 |
1,390 |
$73K |
| D1120 |
Prophylaxis - child |
2,328 |
2,328 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,496 |
10,446 |
$50K |
| D2954 |
|
428 |
389 |
$41K |
| D4341 |
|
872 |
427 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
3,363 |
3,299 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
492 |
403 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,450 |
2,450 |
$26K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
75 |
69 |
$19K |
| D1351 |
Sealant - per tooth |
319 |
148 |
$17K |
| D3320 |
|
13 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
90 |
90 |
$2K |
| D2331 |
|
32 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
184 |
184 |
$2K |
| D0270 |
|
39 |
39 |
$377.95 |
| D2920 |
|
13 |
12 |
$248.27 |