| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
9,009 |
8,224 |
$4.16M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27,649 |
27,563 |
$1.79M |
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,284 |
1,881 |
$1.08M |
| D0210 |
Intraoral - complete series of radiographic images |
18,124 |
18,071 |
$856K |
| D3320 |
|
2,274 |
2,028 |
$829K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,631 |
3,139 |
$673K |
| D7240 |
Removal of impacted tooth - completely bony |
2,871 |
1,222 |
$664K |
| D3348 |
|
1,408 |
1,344 |
$651K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,309 |
1,538 |
$576K |
| D7230 |
|
2,359 |
1,234 |
$448K |
| D3310 |
|
928 |
643 |
$280K |
| D9430 |
|
6,669 |
6,552 |
$211K |
| D2954 |
|
1,949 |
1,657 |
$204K |
| D0330 |
Panoramic radiographic image |
6,696 |
6,662 |
$197K |
| D9222 |
|
1,547 |
1,537 |
$189K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,833 |
9,095 |
$144K |
| D4341 |
|
1,778 |
509 |
$115K |
| D9610 |
|
2,231 |
1,488 |
$113K |
| D1110 |
Prophylaxis - adult |
983 |
975 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
1,703 |
1,699 |
$76K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
847 |
342 |
$55K |
| D3347 |
|
144 |
135 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
3,958 |
3,922 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,787 |
2,766 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,677 |
2,658 |
$31K |
| D4910 |
|
371 |
371 |
$27K |
| D1120 |
Prophylaxis - child |
881 |
872 |
$27K |
| D7220 |
|
179 |
119 |
$26K |
| D3346 |
|
72 |
49 |
$22K |
| D0274 |
Bitewings - four radiographic images |
788 |
788 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
362 |
361 |
$12K |
| D2160 |
|
101 |
58 |
$8K |
| D8670 |
Periodic orthodontic treatment visit |
48 |
39 |
$6K |
| D2140 |
|
75 |
44 |
$4K |
| D4342 |
|
88 |
25 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
36 |
36 |
$1K |