| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
146 |
35 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
427 |
118 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
281 |
144 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
334 |
167 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
339 |
152 |
$17K |
| D1110 |
Prophylaxis - adult |
550 |
518 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
251 |
241 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
33 |
27 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
671 |
650 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
406 |
395 |
$10K |
| D3310 |
|
30 |
12 |
$7K |
| D1120 |
Prophylaxis - child |
290 |
289 |
$6K |
| D3320 |
|
20 |
14 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
334 |
331 |
$5K |
| D2394 |
|
57 |
28 |
$4K |
| D0274 |
Bitewings - four radiographic images |
223 |
206 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
16 |
$3K |
| D0350 |
|
196 |
181 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
217 |
209 |
$994.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
169 |
79 |
$825.00 |
| D0140 |
Limited oral evaluation - problem focused |
29 |
27 |
$564.50 |