| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,263 |
572 |
$122K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,334 |
1,310 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,080 |
1,118 |
$97K |
| D1110 |
Prophylaxis - adult |
2,661 |
2,465 |
$83K |
| D0330 |
Panoramic radiographic image |
1,646 |
1,521 |
$66K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
860 |
578 |
$51K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
168 |
126 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,727 |
1,601 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,607 |
1,500 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,136 |
1,047 |
$16K |
| D2335 |
|
131 |
78 |
$12K |
| D2394 |
|
160 |
122 |
$11K |
| D0274 |
Bitewings - four radiographic images |
619 |
558 |
$11K |
| D1120 |
Prophylaxis - child |
576 |
533 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
636 |
560 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,731 |
1,387 |
$8K |
| D2331 |
|
73 |
46 |
$4K |
| D3320 |
|
19 |
12 |
$4K |
| D2332 |
|
47 |
28 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
60 |
30 |
$2K |
| D2330 |
|
46 |
31 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
472 |
289 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
24 |
$1K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$261.50 |