| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,007 |
427 |
$470K |
| D1110 |
Prophylaxis - adult |
1,361 |
1,331 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,511 |
1,476 |
$31K |
| D2952 |
|
249 |
129 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
388 |
368 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
175 |
85 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
706 |
701 |
$18K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
30 |
24 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
165 |
160 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
233 |
220 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
491 |
412 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
687 |
655 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
28 |
$8K |
| D0274 |
Bitewings - four radiographic images |
203 |
200 |
$7K |
| D2954 |
|
20 |
14 |
$1K |
| D2950 |
|
25 |
12 |
$0.00 |