| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,030 |
584 |
$1.37M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
671 |
445 |
$394K |
| D2954 |
|
1,039 |
576 |
$324K |
| D3320 |
|
392 |
278 |
$137K |
| D3310 |
|
307 |
196 |
$120K |
| D1110 |
Prophylaxis - adult |
1,979 |
1,972 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,134 |
2,128 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,770 |
1,766 |
$35K |
| D2332 |
|
76 |
74 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
324 |
323 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
324 |
324 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
24 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
16 |
$1K |
| D1120 |
Prophylaxis - child |
57 |
57 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
102 |
102 |
$1K |
| D0272 |
Bitewings - two radiographic images |
97 |
97 |
$948.33 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
15 |
$847.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
87 |
87 |
$784.80 |