| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,404 |
9,395 |
$408K |
| D2750 |
|
690 |
578 |
$323K |
| D0120 |
Periodic oral evaluation - established patient |
9,375 |
9,364 |
$202K |
| D0274 |
Bitewings - four radiographic images |
6,693 |
6,692 |
$148K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,437 |
1,126 |
$115K |
| D0220 |
Intraoral - periapical first radiographic image |
9,643 |
9,606 |
$103K |
| D0330 |
Panoramic radiographic image |
2,892 |
2,891 |
$83K |
| D2954 |
|
665 |
565 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,535 |
1,036 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,101 |
2,099 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,864 |
7,858 |
$45K |
| D1120 |
Prophylaxis - child |
1,294 |
1,290 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,773 |
1,755 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,444 |
1,444 |
$16K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
39 |
38 |
$12K |
| D3320 |
|
53 |
51 |
$11K |
| D0272 |
Bitewings - two radiographic images |
386 |
386 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
92 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
26 |
$2K |
| D2331 |
|
24 |
14 |
$1K |
| D9110 |
|
12 |
12 |
$271.15 |