| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
187 |
163 |
$115K |
| D1120 |
Prophylaxis - child |
3,251 |
3,111 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,672 |
4,483 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
3,772 |
3,637 |
$86K |
| D1110 |
Prophylaxis - adult |
2,001 |
1,935 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,081 |
1,979 |
$53K |
| D0330 |
Panoramic radiographic image |
1,337 |
1,259 |
$53K |
| D2140 |
|
843 |
373 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,467 |
2,381 |
$39K |
| D1351 |
Sealant - per tooth |
808 |
222 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
143 |
52 |
$19K |
| D9110 |
|
432 |
398 |
$19K |
| D3320 |
|
37 |
33 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
176 |
101 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
977 |
899 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
52 |
$10K |
| D1206 |
Topical application of fluoride varnish |
190 |
187 |
$4K |
| D0274 |
Bitewings - four radiographic images |
120 |
115 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
30 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
31 |
$698.20 |
| D0145 |
Oral evaluation for a patient under three years of age |
30 |
30 |
$390.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
30 |
$207.64 |
| D9986 |
|
94 |
92 |
$0.00 |
| D1310 |
|
53 |
49 |
$0.00 |