| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
458 |
266 |
$129K |
| D2952 |
|
513 |
323 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
157 |
126 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
260 |
260 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
133 |
133 |
$4K |
| D1110 |
Prophylaxis - adult |
180 |
179 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
904 |
861 |
$3K |
| D3320 |
|
22 |
12 |
$3K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
160 |
146 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
747 |
433 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
71 |
70 |
$1K |
| D0330 |
Panoramic radiographic image |
52 |
51 |
$969.00 |
| D0274 |
Bitewings - four radiographic images |
102 |
99 |
$774.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$120.00 |