| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,084 |
1,833 |
$819K |
| D2740 |
Crown - porcelain/ceramic |
1,488 |
1,036 |
$590K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
880 |
673 |
$295K |
| D2954 |
|
3,071 |
2,318 |
$290K |
| D3320 |
|
651 |
572 |
$216K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,611 |
1,418 |
$212K |
| D1110 |
Prophylaxis - adult |
5,552 |
5,466 |
$198K |
| D0210 |
Intraoral - complete series of radiographic images |
3,306 |
3,276 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
5,642 |
5,563 |
$98K |
| D3348 |
|
249 |
220 |
$96K |
| D0140 |
Limited oral evaluation - problem focused |
5,004 |
4,779 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
949 |
574 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
8,325 |
8,055 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,559 |
3,538 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,410 |
2,392 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,698 |
2,661 |
$40K |
| D1120 |
Prophylaxis - child |
1,510 |
1,510 |
$39K |
| D1351 |
Sealant - per tooth |
1,670 |
229 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
322 |
240 |
$29K |
| D9310 |
|
1,500 |
1,464 |
$26K |
| D3310 |
|
76 |
64 |
$24K |
| D0330 |
Panoramic radiographic image |
800 |
791 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,989 |
4,180 |
$18K |
| D2332 |
|
177 |
112 |
$15K |
| D2335 |
|
139 |
83 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
304 |
133 |
$11K |
| D4910 |
|
160 |
156 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
160 |
120 |
$9K |
| D2752 |
|
32 |
30 |
$9K |
| D0272 |
Bitewings - two radiographic images |
590 |
588 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
659 |
594 |
$7K |
| D0270 |
|
546 |
534 |
$3K |
| D4341 |
|
28 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
433 |
433 |
$2K |
| D9430 |
|
96 |
88 |
$1K |
| D2920 |
|
14 |
12 |
$180.00 |
| D0240 |
|
12 |
12 |
$120.00 |
| D0350 |
|
25 |
25 |
$61.50 |