| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
554 |
429 |
$242K |
| D1110 |
Prophylaxis - adult |
3,709 |
3,707 |
$137K |
| D0274 |
Bitewings - four radiographic images |
3,067 |
3,066 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,009 |
814 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,892 |
2,889 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
5,006 |
4,994 |
$48K |
| D2954 |
|
325 |
276 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,388 |
1,388 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,609 |
4,600 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
363 |
292 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
864 |
863 |
$10K |
| D1120 |
Prophylaxis - child |
300 |
299 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
922 |
920 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
708 |
707 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
12 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$3K |
| D3320 |
|
17 |
13 |
$3K |
| D0272 |
Bitewings - two radiographic images |
191 |
191 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
65 |
$2K |
| D0330 |
Panoramic radiographic image |
66 |
66 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$795.76 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$244.44 |