| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
3,305 |
3,080 |
$2.46M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,626 |
3,784 |
$1.13M |
| D8670 |
Periodic orthodontic treatment visit |
15,593 |
14,990 |
$1.09M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,126 |
7,028 |
$408K |
| D3320 |
|
670 |
617 |
$387K |
| D3348 |
|
425 |
409 |
$358K |
| D0120 |
Periodic oral evaluation - established patient |
7,229 |
7,060 |
$219K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,294 |
2,728 |
$161K |
| D1120 |
Prophylaxis - child |
5,968 |
5,803 |
$149K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,873 |
6,704 |
$141K |
| D1110 |
Prophylaxis - adult |
2,153 |
2,130 |
$140K |
| D8680 |
|
679 |
323 |
$133K |
| D9310 |
|
2,701 |
2,659 |
$126K |
| D7230 |
|
502 |
297 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,691 |
1,979 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,328 |
575 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
8,470 |
8,131 |
$72K |
| D9999 |
Unspecified adjunctive procedure, by report |
574 |
543 |
$58K |
| D7240 |
Removal of impacted tooth - completely bony |
247 |
125 |
$57K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
139 |
134 |
$53K |
| D0274 |
Bitewings - four radiographic images |
5,003 |
4,896 |
$52K |
| D3310 |
|
101 |
70 |
$48K |
| D0470 |
|
950 |
924 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,192 |
6,769 |
$41K |
| D1351 |
Sealant - per tooth |
2,307 |
678 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
726 |
487 |
$35K |
| D3347 |
|
42 |
38 |
$30K |
| D8660 |
|
1,011 |
994 |
$24K |
| D0330 |
Panoramic radiographic image |
558 |
551 |
$16K |
| D0340 |
|
415 |
406 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
767 |
731 |
$14K |
| D0350 |
|
211 |
206 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
325 |
310 |
$7K |
| D0272 |
Bitewings - two radiographic images |
762 |
747 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
369 |
317 |
$7K |
| D0270 |
|
620 |
618 |
$7K |
| D0999 |
Unspecified diagnostic procedure, by report |
98 |
98 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
155 |
125 |
$4K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
13 |
$4K |
| D1999 |
|
40 |
40 |
$2K |
| D1206 |
Topical application of fluoride varnish |
33 |
33 |
$912.00 |
| D2140 |
|
17 |
16 |
$396.00 |
| D9986 |
|
117 |
113 |
$0.00 |
| D1201 |
|
18 |
17 |
$0.00 |
| D1330 |
|
2,422 |
2,321 |
$0.00 |