| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,376 |
1,260 |
$405K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,857 |
1,283 |
$157K |
| D3320 |
|
669 |
598 |
$151K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,796 |
2,017 |
$125K |
| D2950 |
|
2,375 |
2,018 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,133 |
1,538 |
$112K |
| D3310 |
|
555 |
369 |
$90K |
| D0330 |
Panoramic radiographic image |
3,177 |
3,140 |
$86K |
| D2740 |
Crown - porcelain/ceramic |
805 |
624 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,780 |
4,698 |
$65K |
| D1110 |
Prophylaxis - adult |
3,459 |
3,402 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,398 |
925 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
4,427 |
3,464 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
3,385 |
3,272 |
$37K |
| D4341 |
|
2,033 |
792 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
990 |
334 |
$32K |
| D0274 |
Bitewings - four radiographic images |
2,386 |
2,372 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
4,236 |
3,938 |
$19K |
| D2954 |
|
376 |
252 |
$11K |
| D2330 |
|
346 |
187 |
$9K |
| D2332 |
|
236 |
160 |
$9K |
| D2335 |
|
218 |
127 |
$8K |
| D2394 |
|
66 |
55 |
$3K |
| D1120 |
Prophylaxis - child |
271 |
267 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
277 |
262 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
977 |
968 |
$2K |
| D3120 |
|
576 |
383 |
$2K |
| D0272 |
Bitewings - two radiographic images |
156 |
150 |
$2K |
| D3221 |
|
65 |
61 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
125 |
116 |
$482.46 |
| D1208 |
Topical application of fluoride, excluding varnish |
234 |
230 |
$432.48 |
| D1206 |
Topical application of fluoride varnish |
91 |
91 |
$432.47 |
| D4910 |
|
13 |
13 |
$0.00 |
| D5110 |
|
42 |
42 |
$0.00 |
| D5211 |
|
59 |
59 |
$0.00 |
| D1351 |
Sealant - per tooth |
43 |
12 |
$0.00 |
| D2331 |
|
55 |
37 |
$0.00 |
| D5212 |
|
31 |
31 |
$0.00 |
| D2750 |
|
53 |
42 |
$0.00 |
| D5120 |
|
12 |
12 |
$0.00 |