| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
476 |
467 |
$22K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
28 |
27 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
531 |
525 |
$15K |
| D1206 |
Topical application of fluoride varnish |
573 |
562 |
$14K |
| D1110 |
Prophylaxis - adult |
211 |
211 |
$12K |
| D0274 |
Bitewings - four radiographic images |
409 |
401 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
963 |
941 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
51 |
25 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
22 |
14 |
$8K |
| D1120 |
Prophylaxis - child |
184 |
183 |
$8K |
| D2950 |
|
78 |
45 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
63 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
553 |
541 |
$5K |
| D1330 |
|
221 |
216 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$307.11 |