| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
917 |
734 |
$569K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,343 |
2,049 |
$228K |
| D2950 |
|
1,859 |
1,355 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,342 |
3,051 |
$128K |
| D1110 |
Prophylaxis - adult |
3,649 |
3,524 |
$125K |
| D0140 |
Limited oral evaluation - problem focused |
3,544 |
3,389 |
$102K |
| D0274 |
Bitewings - four radiographic images |
2,926 |
2,859 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,509 |
1,447 |
$79K |
| D2791 |
|
185 |
149 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
792 |
583 |
$65K |
| D1120 |
Prophylaxis - child |
1,500 |
1,467 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,680 |
2,616 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
934 |
553 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,736 |
1,702 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,760 |
2,591 |
$32K |
| D0330 |
Panoramic radiographic image |
511 |
474 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
264 |
145 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
329 |
231 |
$19K |
| D9310 |
|
639 |
610 |
$14K |
| D2954 |
|
102 |
87 |
$13K |
| D3320 |
|
17 |
13 |
$11K |
| D3310 |
|
19 |
12 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
398 |
276 |
$4K |
| D1351 |
Sealant - per tooth |
101 |
26 |
$4K |
| D7250 |
|
20 |
12 |
$2K |
| D2140 |
|
36 |
26 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
14 |
$2K |
| D2160 |
|
19 |
18 |
$1K |
| D2331 |
|
17 |
13 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
25 |
$1K |