| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
279 |
190 |
$49K |
| D1110 |
Prophylaxis - adult |
2,415 |
2,387 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
2,257 |
2,230 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
1,167 |
1,162 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
743 |
487 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,124 |
2,098 |
$10K |
| D2954 |
|
282 |
193 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
743 |
740 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
412 |
278 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
2,955 |
2,774 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,914 |
2,281 |
$5K |
| D0274 |
Bitewings - four radiographic images |
916 |
908 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
217 |
107 |
$3K |
| D1120 |
Prophylaxis - child |
208 |
208 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
70 |
$714.00 |