| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,028 |
1,745 |
$1.57M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
9,480 |
4,527 |
$1.47M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,160 |
14,843 |
$712K |
| D3320 |
|
707 |
598 |
$424K |
| D0330 |
Panoramic radiographic image |
7,056 |
6,827 |
$325K |
| D1206 |
Topical application of fluoride varnish |
9,424 |
9,197 |
$163K |
| D1120 |
Prophylaxis - child |
7,575 |
7,364 |
$160K |
| D1110 |
Prophylaxis - adult |
3,114 |
3,044 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
6,011 |
5,869 |
$150K |
| D0220 |
Intraoral - periapical first radiographic image |
16,277 |
14,861 |
$136K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,393 |
502 |
$107K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,431 |
12,086 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
4,764 |
4,660 |
$78K |
| D9999 |
Unspecified adjunctive procedure, by report |
683 |
650 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,949 |
1,334 |
$73K |
| D1351 |
Sealant - per tooth |
4,383 |
1,047 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,466 |
954 |
$44K |
| D0272 |
Bitewings - two radiographic images |
4,803 |
4,612 |
$41K |
| D3310 |
|
80 |
57 |
$38K |
| D4341 |
|
982 |
375 |
$36K |
| D7230 |
|
137 |
84 |
$33K |
| D0274 |
Bitewings - four radiographic images |
3,506 |
3,450 |
$31K |
| D0350 |
|
24,020 |
9,042 |
$30K |
| D9310 |
|
687 |
673 |
$29K |
| D7240 |
Removal of impacted tooth - completely bony |
87 |
51 |
$26K |
| D9430 |
|
1,231 |
1,188 |
$12K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
28 |
27 |
$12K |
| D7220 |
|
24 |
13 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
125 |
99 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
175 |
171 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
873 |
834 |
$4K |
| D4910 |
|
44 |
43 |
$2K |
| D1310 |
|
1,643 |
1,557 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
94 |
93 |
$2K |
| D0270 |
|
1,265 |
1,214 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
348 |
338 |
$1K |
| D0240 |
|
265 |
75 |
$960.00 |
| D9110 |
|
20 |
13 |
$109.00 |
| D0601 |
|
652 |
639 |
$61.00 |
| D0603 |
|
624 |
605 |
$3.00 |
| D9993 |
|
1,536 |
1,500 |
$0.00 |
| D9986 |
|
19 |
18 |
$0.00 |
| D1330 |
|
5,602 |
5,319 |
$0.00 |
| D7250 |
|
42 |
12 |
$0.00 |