| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
46 |
46 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
282 |
188 |
$29K |
| D1110 |
Prophylaxis - adult |
398 |
389 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
186 |
142 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
215 |
148 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
187 |
178 |
$18K |
| D2740 |
Crown - porcelain/ceramic |
22 |
20 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
355 |
340 |
$16K |
| D2331 |
|
130 |
66 |
$16K |
| D2394 |
|
79 |
64 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
338 |
337 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,350 |
464 |
$11K |
| D0274 |
Bitewings - four radiographic images |
267 |
266 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
190 |
184 |
$8K |
| D1206 |
Topical application of fluoride varnish |
286 |
283 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
16 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
57 |
27 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
666 |
644 |
$6K |
| D0330 |
Panoramic radiographic image |
69 |
69 |
$6K |
| D1120 |
Prophylaxis - child |
141 |
141 |
$5K |
| D0350 |
|
206 |
194 |
$4K |
| D0250 |
|
182 |
173 |
$2K |
| D0272 |
Bitewings - two radiographic images |
66 |
64 |
$1K |