| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,492 |
3,465 |
$222K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
506 |
408 |
$219K |
| D2740 |
Crown - porcelain/ceramic |
442 |
323 |
$204K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,987 |
1,426 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
3,352 |
3,332 |
$183K |
| D1120 |
Prophylaxis - child |
3,217 |
3,195 |
$123K |
| D0210 |
Intraoral - complete series of radiographic images |
2,477 |
2,460 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,934 |
897 |
$103K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
870 |
499 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,872 |
6,435 |
$99K |
| D1110 |
Prophylaxis - adult |
1,023 |
1,016 |
$90K |
| D2954 |
|
863 |
586 |
$88K |
| D9430 |
|
2,188 |
2,066 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,324 |
4,296 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,971 |
1,962 |
$41K |
| D0330 |
Panoramic radiographic image |
1,370 |
1,355 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
491 |
310 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
943 |
831 |
$37K |
| D2931 |
|
267 |
184 |
$33K |
| D4910 |
|
422 |
418 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,020 |
1,909 |
$24K |
| D0272 |
Bitewings - two radiographic images |
2,017 |
2,000 |
$23K |
| D3320 |
|
59 |
45 |
$21K |
| D1351 |
Sealant - per tooth |
860 |
269 |
$18K |
| D1320 |
|
929 |
923 |
$16K |
| D7111 |
|
245 |
109 |
$14K |
| D0350 |
|
1,340 |
598 |
$12K |
| D3310 |
|
28 |
14 |
$8K |
| D4341 |
|
175 |
45 |
$8K |
| D2330 |
|
101 |
42 |
$7K |
| D0270 |
|
364 |
347 |
$2K |
| D1310 |
|
15 |
15 |
$689.00 |
| D9993 |
|
60 |
60 |
$0.00 |