| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,343 |
1,242 |
$620K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,713 |
2,482 |
$555K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,724 |
8,706 |
$554K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
944 |
721 |
$448K |
| D0230 |
Intraoral - periapical each additional radiographic image |
65,580 |
10,085 |
$273K |
| D7240 |
Removal of impacted tooth - completely bony |
761 |
365 |
$175K |
| D0120 |
Periodic oral evaluation - established patient |
2,695 |
2,683 |
$141K |
| D7230 |
|
703 |
402 |
$133K |
| D9430 |
|
4,058 |
3,756 |
$127K |
| D0330 |
Panoramic radiographic image |
3,928 |
3,925 |
$115K |
| D3320 |
|
290 |
250 |
$106K |
| D1320 |
|
6,878 |
6,855 |
$104K |
| D2940 |
|
1,699 |
1,119 |
$94K |
| D1120 |
Prophylaxis - child |
2,539 |
2,527 |
$92K |
| D2952 |
|
867 |
668 |
$90K |
| D0272 |
Bitewings - two radiographic images |
7,199 |
7,178 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,168 |
591 |
$78K |
| D1110 |
Prophylaxis - adult |
833 |
825 |
$72K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
519 |
130 |
$51K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
425 |
120 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,637 |
3,613 |
$45K |
| D3348 |
|
65 |
62 |
$30K |
| D3310 |
|
95 |
53 |
$28K |
| D1351 |
Sealant - per tooth |
975 |
272 |
$28K |
| D8670 |
Periodic orthodontic treatment visit |
368 |
359 |
$25K |
| D4910 |
|
302 |
297 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
591 |
526 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
322 |
169 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
341 |
119 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,626 |
1,569 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
193 |
121 |
$15K |
| D4341 |
|
189 |
52 |
$13K |
| D0350 |
|
1,102 |
381 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
165 |
164 |
$7K |
| D0274 |
Bitewings - four radiographic images |
466 |
466 |
$6K |
| D9993 |
|
111 |
111 |
$6K |
| D1310 |
|
111 |
111 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
61 |
$5K |
| D2394 |
|
53 |
40 |
$4K |
| D2160 |
|
43 |
27 |
$3K |
| D0270 |
|
543 |
531 |
$3K |
| D2330 |
|
24 |
15 |
$2K |
| D9110 |
|
13 |
12 |
$819.00 |
| D0140 |
Limited oral evaluation - problem focused |
21 |
21 |
$595.00 |
| D0603 |
|
12 |
12 |
$180.00 |
| D1330 |
|
263 |
262 |
$0.00 |