| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
966 |
714 |
$616K |
| D1110 |
Prophylaxis - adult |
4,635 |
4,629 |
$209K |
| D2954 |
|
666 |
551 |
$102K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
240 |
227 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
4,007 |
4,001 |
$91K |
| D0274 |
Bitewings - four radiographic images |
3,280 |
3,280 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
5,237 |
5,130 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
618 |
520 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
2,947 |
2,806 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,337 |
1,336 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,726 |
2,715 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
348 |
295 |
$17K |
| D0330 |
Panoramic radiographic image |
561 |
558 |
$11K |
| D1120 |
Prophylaxis - child |
257 |
257 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
69 |
56 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
393 |
389 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
39 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
238 |
238 |
$3K |
| D1999 |
|
92 |
91 |
$0.00 |