| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
418 |
331 |
$274K |
| D2752 |
|
511 |
317 |
$266K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
989 |
219 |
$118K |
| D1110 |
Prophylaxis - adult |
1,307 |
1,218 |
$52K |
| D3320 |
|
68 |
56 |
$34K |
| D0330 |
Panoramic radiographic image |
1,043 |
1,005 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,105 |
1,069 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,039 |
999 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
329 |
42 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,065 |
1,010 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
275 |
161 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
554 |
529 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
312 |
265 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
121 |
$3K |