| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
635 |
519 |
$379K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
791 |
727 |
$363K |
| D1110 |
Prophylaxis - adult |
4,614 |
4,614 |
$222K |
| D9310 |
|
2,900 |
2,900 |
$213K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,090 |
1,316 |
$199K |
| D3320 |
|
508 |
451 |
$191K |
| D0220 |
Intraoral - periapical first radiographic image |
7,125 |
7,114 |
$93K |
| D2954 |
|
536 |
457 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,246 |
2,246 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,749 |
1,749 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,732 |
1,732 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,387 |
4,384 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
515 |
343 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
2,439 |
2,436 |
$36K |
| D0330 |
Panoramic radiographic image |
1,403 |
1,403 |
$35K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
64 |
53 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
260 |
255 |
$22K |
| D0270 |
|
1,427 |
1,427 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
713 |
708 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
76 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
26 |
$3K |
| D1999 |
|
290 |
282 |
$0.00 |