| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,254 |
2,030 |
$1.04M |
| D2740 |
Crown - porcelain/ceramic |
2,164 |
1,519 |
$1.02M |
| D3348 |
|
2,148 |
1,843 |
$993K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,303 |
12,258 |
$807K |
| D0330 |
Panoramic radiographic image |
10,501 |
10,466 |
$311K |
| D3320 |
|
582 |
517 |
$213K |
| D3347 |
|
556 |
490 |
$203K |
| D4910 |
|
2,486 |
2,469 |
$190K |
| D4341 |
|
2,570 |
763 |
$180K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,387 |
923 |
$163K |
| D9430 |
|
5,070 |
4,833 |
$161K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,826 |
13,634 |
$144K |
| D2954 |
|
1,335 |
1,011 |
$139K |
| D0210 |
Intraoral - complete series of radiographic images |
2,486 |
2,473 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
1,382 |
1,375 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,261 |
851 |
$84K |
| D1110 |
Prophylaxis - adult |
729 |
727 |
$64K |
| D3346 |
|
135 |
89 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
691 |
442 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,601 |
1,596 |
$33K |
| D3310 |
|
105 |
84 |
$32K |
| D1120 |
Prophylaxis - child |
660 |
660 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,086 |
2,054 |
$25K |
| D0350 |
|
2,754 |
952 |
$19K |
| D7230 |
|
85 |
49 |
$16K |
| D4342 |
|
348 |
120 |
$15K |
| D7240 |
Removal of impacted tooth - completely bony |
57 |
25 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
528 |
527 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
25 |
$2K |
| D2330 |
|
25 |
12 |
$2K |
| D0270 |
|
161 |
161 |
$785.00 |