| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,582 |
1,936 |
$1.52M |
| D3310 |
|
1,219 |
488 |
$475K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
955 |
539 |
$431K |
| D2950 |
|
3,415 |
2,106 |
$368K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,547 |
2,358 |
$329K |
| D3320 |
|
669 |
462 |
$319K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,148 |
1,795 |
$221K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,266 |
1,220 |
$184K |
| D1110 |
Prophylaxis - adult |
3,787 |
3,702 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
5,790 |
5,701 |
$137K |
| D0220 |
Intraoral - periapical first radiographic image |
10,489 |
10,066 |
$127K |
| D1120 |
Prophylaxis - child |
3,806 |
3,748 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,164 |
3,921 |
$118K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,562 |
6,937 |
$101K |
| D9110 |
|
2,072 |
1,973 |
$91K |
| D0330 |
Panoramic radiographic image |
4,653 |
4,520 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,338 |
4,290 |
$86K |
| D2740 |
Crown - porcelain/ceramic |
153 |
67 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
2,813 |
2,719 |
$62K |
| D2940 |
|
1,360 |
943 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,686 |
1,653 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,422 |
2,381 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
565 |
322 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,385 |
1,346 |
$30K |
| D2394 |
|
159 |
108 |
$14K |
| D2931 |
|
74 |
53 |
$10K |
| D2330 |
|
102 |
50 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
55 |
26 |
$4K |
| D2335 |
|
58 |
24 |
$4K |
| D1351 |
Sealant - per tooth |
145 |
48 |
$4K |
| D1206 |
Topical application of fluoride varnish |
53 |
52 |
$1K |
| D4355 |
|
12 |
12 |
$463.10 |
| D3120 |
|
204 |
141 |
$110.14 |