| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
712 |
426 |
$359K |
| D1110 |
Prophylaxis - adult |
2,541 |
2,338 |
$100K |
| D0330 |
Panoramic radiographic image |
1,542 |
1,425 |
$60K |
| D1206 |
Topical application of fluoride varnish |
2,813 |
2,625 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,906 |
1,791 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,352 |
1,225 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,734 |
1,594 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,575 |
1,446 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,023 |
1,839 |
$20K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
38 |
29 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
298 |
163 |
$20K |
| D3320 |
|
31 |
27 |
$16K |
| D1120 |
Prophylaxis - child |
364 |
348 |
$11K |
| D3310 |
|
22 |
12 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
165 |
104 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,703 |
834 |
$9K |
| D5110 |
|
12 |
12 |
$8K |
| D4355 |
|
32 |
32 |
$3K |
| D2954 |
|
22 |
16 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$1K |
| D1330 |
|
54 |
50 |
$0.00 |