| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
922 |
798 |
$323K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,058 |
1,653 |
$191K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,843 |
836 |
$177K |
| D0210 |
Intraoral - complete series of radiographic images |
3,411 |
3,108 |
$152K |
| D1110 |
Prophylaxis - adult |
3,468 |
3,215 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
4,580 |
4,246 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,855 |
3,546 |
$90K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,197 |
857 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,087 |
856 |
$85K |
| D0330 |
Panoramic radiographic image |
2,521 |
2,202 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,548 |
1,011 |
$77K |
| D0274 |
Bitewings - four radiographic images |
2,602 |
2,343 |
$41K |
| D2931 |
|
401 |
315 |
$41K |
| D3320 |
|
151 |
129 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
4,847 |
4,245 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,414 |
2,275 |
$36K |
| D1120 |
Prophylaxis - child |
1,343 |
1,261 |
$34K |
| D1351 |
Sealant - per tooth |
1,538 |
188 |
$31K |
| D2394 |
|
297 |
251 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,489 |
1,403 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,902 |
2,277 |
$23K |
| D9110 |
|
423 |
393 |
$10K |
| D2335 |
|
101 |
50 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
43 |
14 |
$6K |
| D0170 |
|
310 |
277 |
$6K |
| D2332 |
|
21 |
12 |
$2K |