| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
852 |
619 |
$504K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
390 |
226 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,139 |
1,147 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,772 |
2,542 |
$114K |
| D2954 |
|
844 |
513 |
$101K |
| D1110 |
Prophylaxis - adult |
2,599 |
2,525 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,972 |
3,874 |
$81K |
| D0330 |
Panoramic radiographic image |
1,446 |
1,288 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
2,686 |
2,531 |
$78K |
| D0274 |
Bitewings - four radiographic images |
2,344 |
2,278 |
$78K |
| D2791 |
|
151 |
123 |
$65K |
| D1120 |
Prophylaxis - child |
1,302 |
1,294 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
518 |
292 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
485 |
343 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
794 |
778 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,282 |
1,244 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,655 |
2,519 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
432 |
277 |
$27K |
| D3320 |
|
33 |
24 |
$18K |
| D2950 |
|
238 |
181 |
$18K |
| D3310 |
|
44 |
12 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
814 |
519 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
25 |
$4K |