| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,335 |
1,301 |
$77K |
| D1110 |
Prophylaxis - adult |
1,612 |
1,579 |
$53K |
| D2394 |
|
525 |
251 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,528 |
1,493 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
536 |
263 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,735 |
1,702 |
$29K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
40 |
28 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,499 |
1,463 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,066 |
1,051 |
$21K |
| D1120 |
Prophylaxis - child |
932 |
911 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
337 |
162 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
482 |
473 |
$12K |
| D0367 |
|
55 |
55 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,054 |
1,020 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
708 |
526 |
$4K |
| D2161 |
|
31 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
117 |
114 |
$1K |