| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,161 |
1,326 |
$210K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,503 |
731 |
$116K |
| D0140 |
Limited oral evaluation - problem focused |
4,949 |
3,182 |
$115K |
| D1110 |
Prophylaxis - adult |
2,447 |
1,490 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
5,556 |
3,544 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,495 |
1,004 |
$42K |
| D0274 |
Bitewings - four radiographic images |
2,235 |
1,388 |
$40K |
| D2335 |
|
558 |
196 |
$37K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
89 |
72 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,031 |
1,301 |
$22K |
| D0330 |
Panoramic radiographic image |
702 |
474 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,264 |
727 |
$16K |
| D2332 |
|
196 |
89 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
197 |
88 |
$11K |
| D2394 |
|
58 |
38 |
$7K |
| D3310 |
|
48 |
12 |
$6K |
| D4355 |
|
110 |
65 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
50 |
26 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
12 |
$207.48 |