| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,506 |
904 |
$729K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
452 |
411 |
$335K |
| D3320 |
|
487 |
394 |
$314K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,788 |
1,041 |
$240K |
| D1110 |
Prophylaxis - adult |
3,459 |
3,418 |
$226K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,338 |
843 |
$225K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,488 |
560 |
$187K |
| D3310 |
|
328 |
147 |
$179K |
| D2950 |
|
1,492 |
896 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,091 |
2,060 |
$116K |
| D0330 |
Panoramic radiographic image |
2,417 |
2,380 |
$109K |
| D1206 |
Topical application of fluoride varnish |
3,930 |
3,881 |
$100K |
| D0140 |
Limited oral evaluation - problem focused |
1,416 |
1,380 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,703 |
2,662 |
$64K |
| D2394 |
|
360 |
278 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,794 |
1,777 |
$56K |
| D2332 |
|
256 |
116 |
$37K |
| D2335 |
|
124 |
69 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,704 |
1,635 |
$19K |
| D4341 |
|
193 |
56 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
144 |
98 |
$15K |
| D1120 |
Prophylaxis - child |
290 |
289 |
$14K |
| D4355 |
|
112 |
112 |
$11K |
| D3120 |
|
203 |
124 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
439 |
438 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
64 |
64 |
$1K |
| D1330 |
|
58 |
58 |
$417.60 |