| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
594 |
540 |
$485K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,339 |
1,984 |
$289K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,294 |
6,042 |
$234K |
| D3320 |
|
171 |
153 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,837 |
2,160 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
4,762 |
4,547 |
$94K |
| D1120 |
Prophylaxis - child |
4,206 |
4,064 |
$89K |
| D1206 |
Topical application of fluoride varnish |
5,393 |
5,234 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,211 |
1,592 |
$66K |
| D9430 |
|
4,770 |
4,460 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,720 |
7,716 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
9,132 |
8,349 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
2,851 |
2,723 |
$44K |
| D1110 |
Prophylaxis - adult |
1,278 |
1,215 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,018 |
291 |
$35K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
64 |
51 |
$23K |
| D9999 |
Unspecified adjunctive procedure, by report |
278 |
262 |
$20K |
| D0274 |
Bitewings - four radiographic images |
2,130 |
2,070 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
208 |
186 |
$8K |
| D0272 |
Bitewings - two radiographic images |
1,372 |
1,320 |
$7K |
| D0330 |
Panoramic radiographic image |
249 |
246 |
$6K |
| D1351 |
Sealant - per tooth |
303 |
92 |
$6K |
| D0999 |
Unspecified diagnostic procedure, by report |
75 |
75 |
$4K |
| D1310 |
|
780 |
712 |
$3K |
| D9110 |
|
366 |
315 |
$2K |
| D4341 |
|
29 |
13 |
$2K |
| D0270 |
|
1,322 |
1,185 |
$1K |
| D0601 |
|
347 |
300 |
$773.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
24 |
$533.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
64 |
56 |
$405.00 |
| D9995 |
|
85 |
56 |
$300.00 |
| D0140 |
Limited oral evaluation - problem focused |
85 |
56 |
$180.00 |
| D9993 |
|
675 |
638 |
$65.00 |
| D1999 |
|
1,752 |
1,541 |
$30.00 |
| D0603 |
|
121 |
110 |
$21.00 |
| D0602 |
|
14 |
14 |
$2.00 |
| D1330 |
|
8,367 |
7,828 |
$0.00 |