| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2931 |
|
300 |
237 |
$30K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
61 |
59 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,315 |
1,309 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
203 |
126 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
353 |
348 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
60 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
94 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
70 |
69 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
14 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
13 |
$692.28 |