| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,436 |
1,930 |
$248K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,546 |
1,816 |
$174K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
489 |
452 |
$171K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,588 |
988 |
$131K |
| D1110 |
Prophylaxis - adult |
4,102 |
3,922 |
$126K |
| D0274 |
Bitewings - four radiographic images |
5,768 |
5,511 |
$105K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,321 |
929 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,988 |
2,853 |
$72K |
| D2394 |
|
837 |
637 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
3,339 |
3,188 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,465 |
3,357 |
$47K |
| D2335 |
|
381 |
202 |
$31K |
| D3320 |
|
99 |
86 |
$26K |
| D0330 |
Panoramic radiographic image |
558 |
523 |
$21K |
| D2140 |
|
527 |
152 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
4,404 |
4,100 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
779 |
712 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
181 |
107 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
427 |
403 |
$6K |
| D2160 |
|
83 |
61 |
$5K |
| D2332 |
|
52 |
29 |
$3K |
| D2161 |
|
39 |
27 |
$3K |
| D2330 |
|
45 |
25 |
$2K |
| D1120 |
Prophylaxis - child |
81 |
80 |
$2K |
| D2331 |
|
24 |
12 |
$952.35 |