| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2940 |
|
2,985 |
385 |
$155K |
| D0140 |
Limited oral evaluation - problem focused |
1,129 |
946 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
164 |
90 |
$23K |
| D0330 |
Panoramic radiographic image |
393 |
390 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
89 |
57 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
266 |
265 |
$15K |
| D1110 |
Prophylaxis - adult |
174 |
171 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
27 |
$11K |
| D1206 |
Topical application of fluoride varnish |
368 |
367 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
305 |
300 |
$5K |
| D0274 |
Bitewings - four radiographic images |
190 |
190 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
339 |
330 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
13 |
$3K |
| D4355 |
|
12 |
12 |
$1K |