| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,981 |
2,369 |
$521K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
481 |
421 |
$452K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,813 |
1,442 |
$370K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,763 |
1,272 |
$363K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,230 |
1,529 |
$267K |
| D0330 |
Panoramic radiographic image |
3,944 |
3,837 |
$245K |
| D0140 |
Limited oral evaluation - problem focused |
4,331 |
4,181 |
$156K |
| D2950 |
|
1,136 |
741 |
$147K |
| D3320 |
|
185 |
136 |
$130K |
| D2394 |
|
830 |
504 |
$126K |
| D0274 |
Bitewings - four radiographic images |
4,144 |
4,017 |
$122K |
| D1110 |
Prophylaxis - adult |
2,672 |
2,587 |
$95K |
| D1120 |
Prophylaxis - child |
3,075 |
2,864 |
$92K |
| D1206 |
Topical application of fluoride varnish |
5,428 |
5,063 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,426 |
2,126 |
$63K |
| D2330 |
|
549 |
302 |
$41K |
| D3120 |
|
1,145 |
579 |
$40K |
| D2710 |
|
128 |
71 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,450 |
2,347 |
$36K |
| D2332 |
|
323 |
193 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
622 |
576 |
$30K |
| D2740 |
Crown - porcelain/ceramic |
50 |
28 |
$29K |
| D2335 |
|
217 |
117 |
$28K |
| D3310 |
|
40 |
25 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,577 |
781 |
$19K |
| D1351 |
Sealant - per tooth |
975 |
130 |
$15K |
| D2331 |
|
158 |
107 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
96 |
65 |
$12K |
| D0272 |
Bitewings - two radiographic images |
310 |
309 |
$6K |
| D4355 |
|
26 |
26 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$260.00 |
| D1330 |
|
16 |
16 |
$208.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$156.00 |