| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,361 |
1,186 |
$301K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
561 |
401 |
$204K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,347 |
496 |
$150K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,854 |
720 |
$127K |
| D2950 |
|
768 |
512 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,693 |
1,407 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,232 |
1,066 |
$40K |
| D1110 |
Prophylaxis - adult |
1,134 |
992 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,778 |
2,303 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,587 |
1,307 |
$33K |
| D2332 |
|
430 |
141 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,509 |
1,287 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,700 |
1,505 |
$27K |
| D1120 |
Prophylaxis - child |
676 |
557 |
$14K |
| D4355 |
|
106 |
90 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
378 |
309 |
$5K |
| D3310 |
|
19 |
13 |
$5K |
| D1206 |
Topical application of fluoride varnish |
274 |
232 |
$4K |
| D0330 |
Panoramic radiographic image |
32 |
32 |
$2K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$251.55 |
| D1999 |
|
144 |
104 |
$0.00 |