| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
570 |
526 |
$181K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,811 |
2,789 |
$172K |
| D0120 |
Periodic oral evaluation - established patient |
8,488 |
8,152 |
$157K |
| D1120 |
Prophylaxis - child |
4,745 |
4,486 |
$104K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
963 |
389 |
$89K |
| D1110 |
Prophylaxis - adult |
3,459 |
3,313 |
$81K |
| D1206 |
Topical application of fluoride varnish |
10,647 |
10,222 |
$80K |
| D0330 |
Panoramic radiographic image |
2,947 |
2,835 |
$71K |
| D8670 |
Periodic orthodontic treatment visit |
1,080 |
988 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
6,023 |
5,729 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,205 |
3,053 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,017 |
1,300 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,399 |
1,022 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
1,485 |
1,438 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,986 |
1,859 |
$36K |
| D1351 |
Sealant - per tooth |
3,904 |
1,196 |
$31K |
| D7240 |
Removal of impacted tooth - completely bony |
213 |
80 |
$31K |
| D2950 |
|
816 |
697 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
751 |
374 |
$26K |
| D1330 |
|
9,582 |
9,138 |
$25K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
649 |
529 |
$24K |
| 70486 |
|
200 |
196 |
$18K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
134 |
120 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
5,225 |
4,924 |
$12K |
| D0240 |
|
1,907 |
1,564 |
$9K |
| D0272 |
Bitewings - two radiographic images |
3,943 |
3,735 |
$8K |
| D1354 |
|
2,250 |
653 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,412 |
1,629 |
$7K |
| D9248 |
|
79 |
79 |
$5K |
| 70355 |
|
378 |
345 |
$4K |
| D3221 |
|
88 |
82 |
$4K |
| D0274 |
Bitewings - four radiographic images |
1,030 |
969 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
53 |
$2K |
| D9310 |
|
79 |
76 |
$2K |
| D9420 |
|
51 |
51 |
$2K |
| D9222 |
|
143 |
139 |
$1K |
| D0270 |
|
511 |
494 |
$525.82 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
12 |
$490.50 |
| D2331 |
|
19 |
12 |
$368.91 |
| D4346 |
|
14 |
14 |
$342.05 |
| D1208 |
Topical application of fluoride, excluding varnish |
132 |
130 |
$341.81 |
| D9920 |
|
31 |
31 |
$313.92 |
| D2330 |
|
13 |
12 |
$311.50 |