| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
555 |
551 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
210 |
132 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
142 |
80 |
$9K |
| D2931 |
|
64 |
54 |
$7K |
| D0274 |
Bitewings - four radiographic images |
362 |
359 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
136 |
128 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
329 |
328 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$5K |
| D0330 |
Panoramic radiographic image |
137 |
137 |
$5K |
| D1110 |
Prophylaxis - adult |
132 |
131 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
164 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
42 |
$4K |
| D1206 |
Topical application of fluoride varnish |
260 |
260 |
$4K |
| D1120 |
Prophylaxis - child |
181 |
180 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
328 |
316 |
$2K |
| D2160 |
|
23 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
50 |
50 |
$500.00 |