| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,435 |
327 |
$80K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
735 |
195 |
$45K |
| D2931 |
|
241 |
84 |
$28K |
| D2950 |
|
328 |
106 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
534 |
227 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
80 |
28 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
191 |
46 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,540 |
620 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
828 |
313 |
$11K |
| D1110 |
Prophylaxis - adult |
455 |
169 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
1,544 |
633 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
802 |
275 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
354 |
124 |
$6K |
| D0330 |
Panoramic radiographic image |
197 |
71 |
$4K |
| D0272 |
Bitewings - two radiographic images |
325 |
120 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
49 |
13 |
$343.20 |