| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,042 |
763 |
$327K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,086 |
1,671 |
$160K |
| D1110 |
Prophylaxis - adult |
5,709 |
5,623 |
$153K |
| D2952 |
|
930 |
689 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
5,985 |
5,914 |
$76K |
| D1120 |
Prophylaxis - child |
2,323 |
2,303 |
$40K |
| D0274 |
Bitewings - four radiographic images |
3,263 |
3,181 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,241 |
2,206 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,069 |
1,023 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,102 |
2,084 |
$19K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
60 |
52 |
$17K |
| D0330 |
Panoramic radiographic image |
1,502 |
1,461 |
$15K |
| D3320 |
|
15 |
12 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
97 |
97 |
$4K |
| D2335 |
|
61 |
40 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,281 |
1,180 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
25 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
37 |
$44.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$0.00 |