| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,688 |
1,980 |
$195K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
530 |
479 |
$191K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,138 |
1,373 |
$128K |
| D1110 |
Prophylaxis - adult |
3,279 |
3,129 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,963 |
1,180 |
$100K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,767 |
767 |
$89K |
| D0330 |
Panoramic radiographic image |
1,538 |
1,445 |
$65K |
| D2394 |
|
952 |
709 |
$64K |
| D0274 |
Bitewings - four radiographic images |
3,033 |
2,915 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
2,827 |
2,527 |
$57K |
| D2335 |
|
677 |
380 |
$52K |
| D3320 |
|
186 |
162 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
2,844 |
2,745 |
$47K |
| D2740 |
Crown - porcelain/ceramic |
61 |
39 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,686 |
1,599 |
$41K |
| D2331 |
|
592 |
399 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
607 |
340 |
$31K |
| D9944 |
|
173 |
137 |
$26K |
| D2332 |
|
358 |
239 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
4,801 |
4,271 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,260 |
1,255 |
$19K |
| D1120 |
Prophylaxis - child |
834 |
833 |
$16K |
| D2330 |
|
231 |
151 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,651 |
865 |
$7K |
| D2954 |
|
20 |
16 |
$5K |
| D3310 |
|
21 |
16 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
410 |
183 |
$3K |
| D0272 |
Bitewings - two radiographic images |
247 |
246 |
$2K |
| D0470 |
|
14 |
14 |
$308.28 |