| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
853 |
731 |
$616K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,727 |
1,869 |
$499K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,375 |
1,405 |
$344K |
| D3320 |
|
404 |
348 |
$256K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,428 |
957 |
$238K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,075 |
983 |
$217K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,240 |
440 |
$164K |
| D3310 |
|
249 |
140 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,289 |
2,289 |
$125K |
| D4341 |
|
1,088 |
507 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
1,614 |
1,614 |
$89K |
| D7230 |
|
319 |
235 |
$71K |
| D2330 |
|
731 |
467 |
$69K |
| D2740 |
Crown - porcelain/ceramic |
146 |
85 |
$53K |
| D2331 |
|
356 |
239 |
$41K |
| D1110 |
Prophylaxis - adult |
618 |
618 |
$38K |
| D0330 |
Panoramic radiographic image |
636 |
636 |
$29K |
| D2394 |
|
130 |
116 |
$22K |
| D0274 |
Bitewings - four radiographic images |
870 |
870 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
600 |
600 |
$17K |
| D2332 |
|
95 |
64 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
371 |
366 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
76 |
76 |
$3K |
| D2335 |
|
17 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
117 |
117 |
$2K |
| D4910 |
|
24 |
24 |
$1K |