| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
992 |
467 |
$463K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
418 |
325 |
$310K |
| D1110 |
Prophylaxis - adult |
3,770 |
3,665 |
$175K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,063 |
543 |
$123K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
828 |
389 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,077 |
2,015 |
$73K |
| D2950 |
|
818 |
384 |
$69K |
| D3320 |
|
101 |
67 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,539 |
2,482 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
556 |
169 |
$61K |
| D0330 |
Panoramic radiographic image |
1,467 |
1,424 |
$58K |
| D0274 |
Bitewings - four radiographic images |
3,079 |
2,984 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,081 |
2,053 |
$48K |
| D3310 |
|
69 |
26 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
897 |
850 |
$23K |
| D1120 |
Prophylaxis - child |
179 |
176 |
$8K |
| D2332 |
|
53 |
28 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
937 |
883 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
160 |
157 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
86 |
52 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
297 |
244 |
$2K |
| D1330 |
|
140 |
139 |
$774.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$195.00 |