| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
938 |
783 |
$444K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,424 |
702 |
$210K |
| D2950 |
|
1,590 |
1,185 |
$200K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,909 |
1,178 |
$196K |
| D1110 |
Prophylaxis - adult |
3,164 |
3,144 |
$158K |
| D0120 |
Periodic oral evaluation - established patient |
4,498 |
4,476 |
$130K |
| D0272 |
Bitewings - two radiographic images |
4,271 |
4,196 |
$86K |
| D1120 |
Prophylaxis - child |
2,483 |
2,469 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,333 |
3,315 |
$69K |
| D2931 |
|
314 |
253 |
$69K |
| D2160 |
|
413 |
278 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
983 |
975 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,404 |
3,256 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
457 |
272 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,347 |
1,433 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
218 |
130 |
$15K |
| D9945 |
|
32 |
28 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
778 |
755 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
79 |
$9K |
| D2140 |
|
121 |
77 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
47 |
33 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
52 |
$4K |
| D1351 |
Sealant - per tooth |
40 |
13 |
$918.36 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$340.06 |
| D9986 |
|
769 |
699 |
$0.00 |
| D0350 |
|
16 |
16 |
$0.00 |