| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
2,207 |
1,482 |
$1.07M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,101 |
914 |
$819K |
| D1110 |
Prophylaxis - adult |
8,628 |
8,484 |
$503K |
| D0140 |
Limited oral evaluation - problem focused |
10,545 |
8,466 |
$473K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,521 |
1,384 |
$419K |
| D3320 |
|
608 |
498 |
$394K |
| D7230 |
|
1,572 |
810 |
$362K |
| D7240 |
Removal of impacted tooth - completely bony |
947 |
422 |
$287K |
| D0330 |
Panoramic radiographic image |
6,029 |
5,935 |
$263K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,138 |
5,034 |
$249K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,502 |
1,214 |
$245K |
| D0220 |
Intraoral - periapical first radiographic image |
18,864 |
14,198 |
$203K |
| D4341 |
|
2,251 |
754 |
$198K |
| D1206 |
Topical application of fluoride varnish |
6,044 |
5,992 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
5,206 |
5,132 |
$151K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,052 |
597 |
$140K |
| D2954 |
|
1,880 |
1,268 |
$138K |
| D0274 |
Bitewings - four radiographic images |
6,113 |
6,009 |
$136K |
| D2394 |
|
798 |
568 |
$135K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,363 |
10,711 |
$82K |
| D3310 |
|
134 |
85 |
$74K |
| D1120 |
Prophylaxis - child |
1,539 |
1,511 |
$71K |
| D2335 |
|
391 |
261 |
$68K |
| D2332 |
|
441 |
270 |
$63K |
| D2740 |
Crown - porcelain/ceramic |
87 |
71 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
897 |
880 |
$18K |
| D2950 |
|
139 |
108 |
$12K |
| D1330 |
|
1,607 |
1,588 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
45 |
$8K |
| D4910 |
|
111 |
111 |
$6K |
| D0272 |
Bitewings - two radiographic images |
242 |
241 |
$4K |
| D7250 |
|
26 |
14 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
255 |
150 |
$2K |