| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
874 |
749 |
$548K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,247 |
1,434 |
$234K |
| D2950 |
|
1,499 |
1,052 |
$180K |
| D1110 |
Prophylaxis - adult |
2,989 |
2,952 |
$128K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
895 |
348 |
$111K |
| D1120 |
Prophylaxis - child |
3,146 |
3,099 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,202 |
5,134 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,867 |
3,810 |
$94K |
| D2140 |
|
1,556 |
782 |
$92K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
185 |
136 |
$90K |
| D3320 |
|
182 |
144 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,176 |
3,124 |
$89K |
| D0274 |
Bitewings - four radiographic images |
3,237 |
3,180 |
$84K |
| D0330 |
Panoramic radiographic image |
2,392 |
2,346 |
$82K |
| D3310 |
|
184 |
86 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
980 |
526 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
5,116 |
4,564 |
$50K |
| D2160 |
|
572 |
369 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
588 |
238 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,104 |
1,075 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,825 |
1,975 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
653 |
584 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,051 |
1,031 |
$18K |
| D1351 |
Sealant - per tooth |
536 |
152 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
201 |
139 |
$16K |
| D2332 |
|
186 |
102 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
149 |
$14K |
| D2740 |
Crown - porcelain/ceramic |
26 |
12 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
26 |
26 |
$541.20 |
| D0180 |
|
484 |
464 |
$32.96 |