| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,128 |
1,040 |
$634K |
| D2740 |
Crown - porcelain/ceramic |
1,017 |
740 |
$498K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,941 |
1,020 |
$263K |
| D1110 |
Prophylaxis - adult |
4,378 |
4,217 |
$200K |
| D0140 |
Limited oral evaluation - problem focused |
5,439 |
5,253 |
$192K |
| D0330 |
Panoramic radiographic image |
2,565 |
2,510 |
$133K |
| D3348 |
|
163 |
153 |
$131K |
| D2950 |
|
843 |
614 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
4,229 |
4,091 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,368 |
2,279 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
5,867 |
5,655 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
453 |
276 |
$73K |
| D0460 |
|
2,288 |
2,219 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
735 |
703 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,535 |
1,478 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
209 |
148 |
$32K |
| D1354 |
|
595 |
53 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
192 |
113 |
$20K |
| D0270 |
|
1,155 |
1,142 |
$15K |
| D2332 |
|
49 |
26 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
110 |
101 |
$2K |
| D1206 |
Topical application of fluoride varnish |
39 |
39 |
$669.57 |