| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
888 |
835 |
$410K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,439 |
3,426 |
$222K |
| D0210 |
Intraoral - complete series of radiographic images |
2,916 |
2,908 |
$136K |
| D2740 |
Crown - porcelain/ceramic |
266 |
174 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,865 |
847 |
$124K |
| D9430 |
|
2,495 |
2,421 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
1,190 |
1,189 |
$71K |
| D4910 |
|
637 |
635 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,943 |
2,977 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
693 |
332 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,122 |
3,053 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
311 |
150 |
$36K |
| D0350 |
|
2,860 |
958 |
$30K |
| D2954 |
|
253 |
161 |
$26K |
| D0330 |
Panoramic radiographic image |
891 |
887 |
$25K |
| D4341 |
|
356 |
94 |
$25K |
| D1120 |
Prophylaxis - child |
610 |
609 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
95 |
64 |
$8K |
| D3320 |
|
20 |
16 |
$7K |
| D3348 |
|
12 |
12 |
$6K |
| D1206 |
Topical application of fluoride varnish |
373 |
373 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
192 |
192 |
$2K |
| D3221 |
|
25 |
25 |
$2K |
| D0270 |
|
99 |
99 |
$495.00 |
| D0274 |
Bitewings - four radiographic images |
21 |
21 |
$410.40 |