| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
185 |
184 |
$45K |
| D1110 |
Prophylaxis - adult |
1,430 |
1,399 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,024 |
450 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
713 |
447 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
795 |
786 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
556 |
405 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,011 |
982 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
194 |
149 |
$19K |
| D2950 |
|
373 |
342 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
716 |
702 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
892 |
878 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
941 |
926 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
87 |
60 |
$8K |
| D2332 |
|
150 |
73 |
$7K |
| D0274 |
Bitewings - four radiographic images |
455 |
450 |
$7K |
| D3320 |
|
17 |
13 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
343 |
220 |
$5K |
| D1120 |
Prophylaxis - child |
48 |
48 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
46 |
46 |
$1K |
| D2954 |
|
20 |
14 |
$0.00 |
| D4341 |
|
56 |
30 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
31 |
31 |
$0.00 |