| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,634 |
1,554 |
$754K |
| D9430 |
|
5,122 |
5,069 |
$162K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,100 |
703 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,324 |
1,318 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
987 |
662 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,044 |
1,030 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,539 |
3,513 |
$40K |
| D0330 |
Panoramic radiographic image |
1,070 |
1,063 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
636 |
636 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,183 |
5,364 |
$27K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
52 |
42 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
193 |
142 |
$10K |
| D0274 |
Bitewings - four radiographic images |
486 |
485 |
$10K |
| D3320 |
|
25 |
25 |
$9K |
| D1120 |
Prophylaxis - child |
260 |
255 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
85 |
74 |
$7K |
| D2954 |
|
33 |
27 |
$3K |
| D1110 |
Prophylaxis - adult |
54 |
54 |
$3K |
| D0270 |
|
537 |
521 |
$3K |
| D4341 |
|
40 |
12 |
$2K |
| D3221 |
|
28 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
118 |
118 |
$1K |
| D1206 |
Topical application of fluoride varnish |
68 |
68 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$918.40 |