| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
3,594 |
3,382 |
$1.66M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
23,504 |
23,432 |
$1.53M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
9,932 |
4,826 |
$1.18M |
| D2740 |
Crown - porcelain/ceramic |
1,893 |
1,440 |
$901K |
| D0210 |
Intraoral - complete series of radiographic images |
17,833 |
17,765 |
$849K |
| D3320 |
|
1,607 |
1,425 |
$587K |
| D0120 |
Periodic oral evaluation - established patient |
9,064 |
9,020 |
$555K |
| D7240 |
Removal of impacted tooth - completely bony |
2,066 |
946 |
$477K |
| D0230 |
Intraoral - periapical each additional radiographic image |
101,077 |
15,598 |
$410K |
| D7230 |
|
1,864 |
1,111 |
$352K |
| D1120 |
Prophylaxis - child |
8,878 |
8,841 |
$344K |
| D9430 |
|
9,269 |
9,192 |
$297K |
| D0330 |
Panoramic radiographic image |
9,366 |
9,331 |
$278K |
| D4341 |
|
3,824 |
1,179 |
$267K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,905 |
2,139 |
$267K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,889 |
2,286 |
$261K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,134 |
1,341 |
$210K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,061 |
1,452 |
$175K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,372 |
529 |
$161K |
| D1351 |
Sealant - per tooth |
5,259 |
1,697 |
$155K |
| D1110 |
Prophylaxis - adult |
1,870 |
1,859 |
$155K |
| D8670 |
Periodic orthodontic treatment visit |
543 |
542 |
$149K |
| D3310 |
|
491 |
335 |
$148K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,231 |
3,188 |
$128K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,267 |
488 |
$125K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,800 |
8,769 |
$117K |
| D0272 |
Bitewings - two radiographic images |
9,274 |
9,232 |
$107K |
| D2160 |
|
1,338 |
786 |
$106K |
| D1310 |
|
1,478 |
1,477 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
5,592 |
5,557 |
$66K |
| D4342 |
|
1,389 |
522 |
$58K |
| D4910 |
|
644 |
644 |
$50K |
| D9993 |
|
774 |
774 |
$47K |
| D2931 |
|
363 |
278 |
$46K |
| D1510 |
|
245 |
167 |
$43K |
| D2954 |
|
360 |
258 |
$37K |
| D0340 |
|
669 |
668 |
$33K |
| D3348 |
|
59 |
56 |
$27K |
| D2161 |
|
261 |
172 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
277 |
204 |
$22K |
| D7220 |
|
127 |
86 |
$18K |
| D0603 |
|
1,095 |
1,094 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
348 |
347 |
$12K |
| D4355 |
|
83 |
83 |
$8K |
| D3346 |
|
19 |
15 |
$6K |
| D7111 |
|
50 |
26 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$2K |
| D2331 |
|
18 |
13 |
$1K |
| D2140 |
|
19 |
12 |
$1K |
| D0350 |
|
94 |
37 |
$902.40 |
| D0601 |
|
27 |
27 |
$405.00 |