| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
371 |
297 |
$198K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,142 |
658 |
$172K |
| D1110 |
Prophylaxis - adult |
2,427 |
2,365 |
$114K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,715 |
1,126 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,421 |
913 |
$91K |
| D0330 |
Panoramic radiographic image |
1,138 |
1,099 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
2,028 |
1,839 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
1,806 |
1,764 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,144 |
1,111 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
507 |
380 |
$37K |
| D2740 |
Crown - porcelain/ceramic |
44 |
27 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,278 |
1,229 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,067 |
1,817 |
$15K |
| D1120 |
Prophylaxis - child |
539 |
522 |
$14K |
| D0274 |
Bitewings - four radiographic images |
472 |
460 |
$12K |
| D2950 |
|
65 |
54 |
$5K |
| D3310 |
|
19 |
12 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
690 |
437 |
$5K |
| D2394 |
|
49 |
41 |
$4K |
| D2330 |
|
63 |
37 |
$3K |
| D2331 |
|
29 |
25 |
$2K |
| D2332 |
|
13 |
12 |
$804.50 |
| D0272 |
Bitewings - two radiographic images |
45 |
44 |
$624.45 |