| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,075 |
1,036 |
$492K |
| D2740 |
Crown - porcelain/ceramic |
1,098 |
903 |
$424K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,348 |
2,478 |
$341K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,256 |
2,272 |
$270K |
| D1110 |
Prophylaxis - adult |
7,398 |
7,127 |
$256K |
| D3320 |
|
722 |
658 |
$223K |
| D2950 |
|
2,458 |
2,092 |
$190K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,155 |
706 |
$181K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,410 |
6,002 |
$158K |
| D3310 |
|
328 |
240 |
$127K |
| D0210 |
Intraoral - complete series of radiographic images |
4,271 |
3,999 |
$117K |
| D0272 |
Bitewings - two radiographic images |
7,491 |
7,314 |
$95K |
| D2331 |
|
1,206 |
729 |
$86K |
| D2330 |
|
1,002 |
600 |
$66K |
| D0330 |
Panoramic radiographic image |
1,560 |
1,544 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
7,466 |
5,657 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
3,870 |
3,436 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,678 |
2,633 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
679 |
143 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,895 |
2,326 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
583 |
428 |
$27K |
| D2332 |
|
341 |
238 |
$22K |
| D1120 |
Prophylaxis - child |
812 |
793 |
$20K |
| D4355 |
|
453 |
445 |
$9K |
| D0274 |
Bitewings - four radiographic images |
207 |
176 |
$4K |
| D9310 |
|
105 |
105 |
$0.00 |
| D4341 |
|
932 |
237 |
$0.00 |
| D4910 |
|
12 |
12 |
$0.00 |