| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
596 |
388 |
$291K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
874 |
489 |
$116K |
| D1110 |
Prophylaxis - adult |
1,352 |
1,326 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
441 |
295 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,315 |
1,282 |
$72K |
| D0330 |
Panoramic radiographic image |
1,471 |
1,432 |
$66K |
| D2950 |
|
602 |
394 |
$51K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
62 |
58 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,712 |
1,682 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
667 |
645 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,268 |
1,240 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
185 |
81 |
$25K |
| D3320 |
|
34 |
31 |
$22K |
| D2394 |
|
76 |
66 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
392 |
391 |
$12K |
| D4341 |
|
133 |
41 |
$11K |
| D3310 |
|
16 |
12 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
650 |
631 |
$7K |
| D1120 |
Prophylaxis - child |
90 |
90 |
$4K |
| D3120 |
|
98 |
76 |
$3K |
| D4355 |
|
16 |
15 |
$2K |
| D1330 |
|
106 |
106 |
$763.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
105 |
105 |
$708.48 |