| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
869 |
619 |
$384K |
| D1110 |
Prophylaxis - adult |
3,610 |
3,606 |
$146K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,587 |
1,134 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
2,684 |
2,683 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,641 |
2,641 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
1,482 |
1,440 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,763 |
1,760 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,153 |
3,124 |
$31K |
| D2954 |
|
177 |
160 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,707 |
2,699 |
$15K |
| D1120 |
Prophylaxis - child |
377 |
377 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
238 |
159 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
821 |
788 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
302 |
302 |
$3K |
| D3320 |
|
14 |
12 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
13 |
$831.60 |
| D1999 |
|
305 |
288 |
$0.00 |