| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
498 |
472 |
$229K |
| D0120 |
Periodic oral evaluation - established patient |
3,559 |
3,549 |
$189K |
| D1120 |
Prophylaxis - child |
4,213 |
4,207 |
$159K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,256 |
778 |
$143K |
| D9430 |
|
3,746 |
3,631 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,571 |
1,570 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,428 |
583 |
$93K |
| D0274 |
Bitewings - four radiographic images |
2,681 |
2,678 |
$54K |
| D2740 |
Crown - porcelain/ceramic |
106 |
77 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
1,093 |
1,092 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,293 |
7,496 |
$48K |
| D0350 |
|
5,226 |
1,498 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,552 |
3,467 |
$42K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
452 |
200 |
$30K |
| D1351 |
Sealant - per tooth |
1,370 |
275 |
$29K |
| D1206 |
Topical application of fluoride varnish |
2,241 |
2,239 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
374 |
159 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,684 |
1,681 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,224 |
1,192 |
$14K |
| D2954 |
|
118 |
89 |
$11K |
| D3320 |
|
15 |
12 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
68 |
51 |
$5K |
| D2140 |
|
89 |
48 |
$5K |
| D7111 |
|
36 |
27 |
$2K |
| D1330 |
|
20 |
20 |
$0.00 |