| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
927 |
467 |
$438K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
320 |
277 |
$236K |
| D1110 |
Prophylaxis - adult |
2,456 |
2,400 |
$155K |
| D3320 |
|
159 |
114 |
$101K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
442 |
337 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
1,521 |
1,311 |
$71K |
| D1206 |
Topical application of fluoride varnish |
2,661 |
2,594 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,088 |
2,059 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
992 |
976 |
$55K |
| D3310 |
|
96 |
38 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
333 |
237 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,504 |
1,488 |
$35K |
| D1120 |
Prophylaxis - child |
782 |
759 |
$35K |
| D7240 |
Removal of impacted tooth - completely bony |
79 |
51 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,005 |
979 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,759 |
1,503 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
26 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
160 |
159 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
25 |
$3K |
| D2332 |
|
23 |
13 |
$3K |
| D1351 |
Sealant - per tooth |
102 |
14 |
$3K |
| D2394 |
|
21 |
13 |
$3K |
| D1330 |
|
368 |
336 |
$2K |
| D0330 |
Panoramic radiographic image |
33 |
33 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$196.92 |