| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
42 |
28 |
$21K |
| D0274 |
Bitewings - four radiographic images |
286 |
273 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
322 |
314 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
14 |
$9K |
| D1110 |
Prophylaxis - adult |
98 |
98 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
270 |
269 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
382 |
327 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
112 |
109 |
$5K |
| D0330 |
Panoramic radiographic image |
76 |
69 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
13 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
36 |
36 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
97 |
79 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$564.00 |