| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
355 |
275 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,455 |
904 |
$144K |
| D1110 |
Prophylaxis - adult |
2,566 |
2,511 |
$117K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
500 |
363 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,264 |
1,231 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,146 |
2,089 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,182 |
1,084 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
481 |
296 |
$38K |
| D0330 |
Panoramic radiographic image |
916 |
897 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,695 |
1,672 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,494 |
1,470 |
$33K |
| D2950 |
|
264 |
217 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
252 |
161 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,620 |
1,464 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$10K |
| D1351 |
Sealant - per tooth |
102 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
108 |
105 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
243 |
234 |
$2K |
| D8670 |
Periodic orthodontic treatment visit |
15 |
14 |
$1K |
| D1120 |
Prophylaxis - child |
15 |
12 |
$635.55 |
| D1330 |
|
81 |
75 |
$486.00 |
| D0272 |
Bitewings - two radiographic images |
18 |
18 |
$277.05 |