| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,204 |
1,034 |
$697K |
| D1110 |
Prophylaxis - adult |
6,595 |
6,575 |
$289K |
| D0120 |
Periodic oral evaluation - established patient |
7,495 |
7,471 |
$204K |
| D1120 |
Prophylaxis - child |
3,871 |
3,861 |
$177K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,862 |
1,976 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,898 |
1,966 |
$155K |
| D0140 |
Limited oral evaluation - problem focused |
3,583 |
3,471 |
$155K |
| D1206 |
Topical application of fluoride varnish |
4,439 |
4,428 |
$141K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
242 |
214 |
$123K |
| D0210 |
Intraoral - complete series of radiographic images |
1,506 |
1,506 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,670 |
2,665 |
$71K |
| D2950 |
|
1,010 |
887 |
$57K |
| D0274 |
Bitewings - four radiographic images |
4,058 |
4,044 |
$46K |
| D0330 |
Panoramic radiographic image |
1,538 |
1,522 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
4,055 |
3,859 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
404 |
298 |
$17K |
| D2332 |
|
182 |
126 |
$14K |
| D3320 |
|
17 |
15 |
$7K |
| D0272 |
Bitewings - two radiographic images |
413 |
411 |
$4K |
| D1351 |
Sealant - per tooth |
163 |
17 |
$4K |
| D2394 |
|
45 |
38 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,144 |
945 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$321.75 |