| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
265 |
147 |
$83K |
| D1110 |
Prophylaxis - adult |
1,429 |
1,331 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,408 |
1,222 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,763 |
1,705 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,388 |
1,294 |
$23K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
46 |
41 |
$22K |
| D0274 |
Bitewings - four radiographic images |
973 |
904 |
$20K |
| D1120 |
Prophylaxis - child |
339 |
331 |
$9K |
| D0330 |
Panoramic radiographic image |
117 |
115 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
202 |
198 |
$4K |
| D0272 |
Bitewings - two radiographic images |
200 |
196 |
$3K |
| D2161 |
|
51 |
42 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
111 |
104 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
55 |
27 |
$0.00 |