| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
591 |
304 |
$241K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,176 |
755 |
$148K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
192 |
159 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
3,278 |
3,214 |
$76K |
| D1120 |
Prophylaxis - child |
2,431 |
2,392 |
$76K |
| D1110 |
Prophylaxis - adult |
1,873 |
1,828 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,300 |
3,250 |
$64K |
| D0272 |
Bitewings - two radiographic images |
2,866 |
2,798 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
638 |
268 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,172 |
1,144 |
$31K |
| D0330 |
Panoramic radiographic image |
901 |
870 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
238 |
102 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
343 |
145 |
$27K |
| D1351 |
Sealant - per tooth |
458 |
121 |
$11K |
| D4355 |
|
131 |
129 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
157 |
153 |
$8K |
| D3320 |
|
20 |
13 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
340 |
328 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
319 |
300 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
13 |
$3K |
| D2950 |
|
55 |
39 |
$3K |
| D0274 |
Bitewings - four radiographic images |
119 |
118 |
$2K |