| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
223 |
201 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
756 |
396 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
748 |
718 |
$39K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
294 |
148 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
941 |
907 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
446 |
282 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
266 |
203 |
$21K |
| D1110 |
Prophylaxis - adult |
610 |
594 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
434 |
161 |
$20K |
| D0330 |
Panoramic radiographic image |
506 |
471 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
826 |
783 |
$19K |
| D2931 |
|
132 |
116 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,059 |
930 |
$9K |
| D0274 |
Bitewings - four radiographic images |
343 |
325 |
$6K |
| D1206 |
Topical application of fluoride varnish |
326 |
310 |
$5K |
| D3320 |
|
14 |
13 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
964 |
497 |
$4K |
| D2394 |
|
51 |
43 |
$4K |
| D1120 |
Prophylaxis - child |
151 |
141 |
$4K |
| D9110 |
|
63 |
62 |
$2K |
| D2335 |
|
17 |
12 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
62 |
62 |
$1K |
| D0170 |
|
42 |
41 |
$879.39 |