| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
610 |
483 |
$371K |
| D1110 |
Prophylaxis - adult |
3,309 |
3,309 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
4,039 |
4,039 |
$120K |
| D2952 |
|
633 |
547 |
$89K |
| D2791 |
|
180 |
161 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
1,787 |
1,781 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,187 |
1,187 |
$33K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
57 |
48 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
902 |
902 |
$30K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
57 |
52 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,540 |
1,537 |
$22K |
| D9243 |
|
78 |
76 |
$18K |
| D0330 |
Panoramic radiographic image |
440 |
440 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
136 |
122 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
208 |
172 |
$11K |
| D9110 |
|
251 |
251 |
$7K |
| D9239 |
|
51 |
50 |
$4K |
| D3320 |
|
12 |
12 |
$4K |
| D9310 |
|
39 |
39 |
$3K |
| D9945 |
|
12 |
12 |
$3K |
| D1999 |
|
35 |
31 |
$0.00 |