| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
842 |
747 |
$315K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,346 |
1,762 |
$295K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,915 |
776 |
$184K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,527 |
1,034 |
$174K |
| D0140 |
Limited oral evaluation - problem focused |
4,783 |
4,070 |
$153K |
| D1110 |
Prophylaxis - adult |
4,253 |
3,623 |
$140K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,929 |
1,166 |
$130K |
| D0330 |
Panoramic radiographic image |
2,035 |
1,725 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,746 |
2,142 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
1,193 |
886 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
4,586 |
3,766 |
$59K |
| D2335 |
|
509 |
294 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,232 |
2,036 |
$51K |
| D3310 |
|
153 |
124 |
$44K |
| D2394 |
|
277 |
163 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,451 |
1,266 |
$39K |
| D4355 |
|
658 |
529 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,712 |
1,404 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,893 |
861 |
$18K |
| D2332 |
|
165 |
107 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
196 |
89 |
$11K |
| D2330 |
|
83 |
68 |
$5K |
| D1120 |
Prophylaxis - child |
126 |
83 |
$2K |
| D2331 |
|
21 |
12 |
$2K |
| D0170 |
|
14 |
12 |
$331.16 |