| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,759 |
1,633 |
$648K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,035 |
2,689 |
$468K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,828 |
3,576 |
$314K |
| D1110 |
Prophylaxis - adult |
7,320 |
7,164 |
$252K |
| D2160 |
|
3,686 |
2,508 |
$240K |
| D0140 |
Limited oral evaluation - problem focused |
7,974 |
7,466 |
$168K |
| D0330 |
Panoramic radiographic image |
3,780 |
3,676 |
$166K |
| D3320 |
|
533 |
484 |
$149K |
| D2140 |
|
2,732 |
1,891 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
6,417 |
6,276 |
$108K |
| D2161 |
|
1,442 |
1,155 |
$107K |
| D7230 |
|
723 |
263 |
$105K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,902 |
883 |
$103K |
| D0274 |
Bitewings - four radiographic images |
5,072 |
4,951 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,693 |
3,606 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,230 |
4,113 |
$62K |
| D1120 |
Prophylaxis - child |
2,894 |
2,815 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
9,203 |
8,426 |
$45K |
| D2332 |
|
649 |
388 |
$45K |
| D2335 |
|
287 |
181 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
1,040 |
599 |
$21K |
| D7240 |
Removal of impacted tooth - completely bony |
110 |
39 |
$18K |
| D3310 |
|
65 |
51 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,503 |
2,059 |
$16K |
| D1351 |
Sealant - per tooth |
639 |
169 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,338 |
1,309 |
$13K |
| D2931 |
|
107 |
93 |
$12K |
| D2330 |
|
103 |
70 |
$5K |
| D2331 |
|
75 |
57 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
57 |
51 |
$1K |