| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,892 |
5,890 |
$249K |
| D2750 |
|
341 |
258 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
5,522 |
5,520 |
$124K |
| D0274 |
Bitewings - four radiographic images |
5,663 |
5,661 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,342 |
974 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
8,262 |
8,241 |
$96K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
201 |
193 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,826 |
5,819 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,837 |
1,836 |
$42K |
| D1120 |
Prophylaxis - child |
538 |
538 |
$22K |
| D9310 |
|
565 |
565 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
303 |
215 |
$21K |
| D0330 |
Panoramic radiographic image |
717 |
717 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
1,000 |
993 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
628 |
628 |
$8K |
| D0272 |
Bitewings - two radiographic images |
526 |
525 |
$7K |
| D2954 |
|
58 |
54 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
58 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
71 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
1,633 |
1,626 |
$4K |