| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,969 |
4,969 |
$319K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,354 |
1,145 |
$260K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
291 |
284 |
$218K |
| D0120 |
Periodic oral evaluation - established patient |
4,949 |
4,948 |
$169K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
756 |
672 |
$102K |
| D2780 |
|
72 |
69 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,331 |
1,331 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
499 |
496 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,720 |
1,681 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
482 |
482 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
705 |
705 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
381 |
374 |
$18K |
| D9310 |
|
167 |
167 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
24 |
$6K |
| D1120 |
Prophylaxis - child |
113 |
113 |
$5K |
| D2330 |
|
13 |
13 |
$2K |