| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,354 |
1,227 |
$233K |
| D2394 |
|
955 |
618 |
$124K |
| D0274 |
Bitewings - four radiographic images |
3,507 |
3,310 |
$102K |
| D1110 |
Prophylaxis - adult |
2,902 |
2,730 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,697 |
4,481 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,844 |
2,162 |
$95K |
| D0330 |
Panoramic radiographic image |
2,874 |
1,788 |
$91K |
| D1120 |
Prophylaxis - child |
1,867 |
1,819 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
2,682 |
2,596 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
2,637 |
2,181 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
5,858 |
5,246 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
860 |
634 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,244 |
3,751 |
$45K |
| D3110 |
|
145 |
77 |
$15K |
| D7250 |
|
310 |
54 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
42 |
14 |
$13K |
| D2954 |
|
141 |
65 |
$8K |
| D2332 |
|
83 |
51 |
$8K |
| D2160 |
|
47 |
28 |
$3K |
| D2161 |
|
15 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
12 |
$1K |