| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,678 |
1,203 |
$790K |
| D1110 |
Prophylaxis - adult |
4,937 |
4,904 |
$186K |
| D0140 |
Limited oral evaluation - problem focused |
2,567 |
2,479 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
3,959 |
3,934 |
$97K |
| D0210 |
Intraoral - complete series of radiographic images |
2,065 |
2,045 |
$83K |
| D2950 |
|
1,238 |
912 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,356 |
1,349 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
549 |
355 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,352 |
1,348 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,816 |
2,746 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
692 |
690 |
$13K |
| D0160 |
|
408 |
408 |
$13K |
| D4355 |
|
135 |
135 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
231 |
148 |
$10K |
| D1120 |
Prophylaxis - child |
213 |
213 |
$8K |
| D2954 |
|
77 |
64 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
899 |
867 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
31 |
$3K |
| D2332 |
|
13 |
12 |
$789.25 |
| D2330 |
|
15 |
12 |
$701.50 |
| D9110 |
|
35 |
30 |
$605.00 |