| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
946 |
564 |
$1.27M |
| D1110 |
Prophylaxis - adult |
1,962 |
1,958 |
$87K |
| D2952 |
|
311 |
210 |
$83K |
| D2954 |
|
100 |
90 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,918 |
1,899 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
2,437 |
2,306 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,302 |
1,297 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
886 |
881 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
70 |
$17K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
618 |
604 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
14 |
$5K |
| D0272 |
Bitewings - two radiographic images |
129 |
128 |
$1K |