| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,303 |
1,283 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
775 |
443 |
$59K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
107 |
102 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
737 |
219 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,702 |
1,694 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
371 |
247 |
$37K |
| D1110 |
Prophylaxis - adult |
626 |
620 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
264 |
162 |
$19K |
| D0330 |
Panoramic radiographic image |
293 |
292 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
457 |
447 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
508 |
503 |
$12K |
| D0274 |
Bitewings - four radiographic images |
432 |
427 |
$12K |
| D1120 |
Prophylaxis - child |
366 |
366 |
$9K |
| D3320 |
|
16 |
14 |
$9K |
| D1206 |
Topical application of fluoride varnish |
427 |
425 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,065 |
529 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,027 |
998 |
$7K |