| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
609 |
393 |
$291K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,839 |
824 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,238 |
1,210 |
$70K |
| D1110 |
Prophylaxis - adult |
1,221 |
1,210 |
$69K |
| D0330 |
Panoramic radiographic image |
998 |
973 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,682 |
1,653 |
$53K |
| D4341 |
|
356 |
136 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
371 |
196 |
$28K |
| D4910 |
|
510 |
493 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,074 |
1,062 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
450 |
442 |
$20K |
| D2954 |
|
244 |
181 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
808 |
807 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,172 |
1,146 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
90 |
65 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
96 |
51 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
759 |
745 |
$9K |
| D2394 |
|
38 |
25 |
$6K |
| D2950 |
|
90 |
54 |
$0.00 |