| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
469 |
302 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
6,248 |
6,243 |
$93K |
| D1110 |
Prophylaxis - adult |
5,576 |
5,573 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,027 |
602 |
$35K |
| D1120 |
Prophylaxis - child |
1,501 |
1,500 |
$29K |
| D0274 |
Bitewings - four radiographic images |
3,164 |
3,162 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,747 |
1,743 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
713 |
713 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
7,823 |
7,762 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,485 |
6,642 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,784 |
1,782 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
731 |
715 |
$15K |
| D2950 |
|
424 |
283 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
385 |
254 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
370 |
234 |
$14K |
| D9310 |
|
1,265 |
1,261 |
$13K |
| D0330 |
Panoramic radiographic image |
1,573 |
1,571 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,470 |
1,468 |
$8K |
| D4341 |
|
174 |
91 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
70 |
$4K |
| D2752 |
|
14 |
13 |
$4K |
| D0270 |
|
59 |
59 |
$143.30 |