| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
5,788 |
5,411 |
$2.66M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
12,005 |
5,460 |
$1.41M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20,382 |
20,322 |
$1.27M |
| D0120 |
Periodic oral evaluation - established patient |
13,477 |
13,439 |
$677K |
| D0230 |
Intraoral - periapical each additional radiographic image |
161,029 |
30,066 |
$662K |
| D3320 |
|
1,642 |
1,478 |
$598K |
| D0274 |
Bitewings - four radiographic images |
21,798 |
21,746 |
$454K |
| D2740 |
Crown - porcelain/ceramic |
823 |
566 |
$386K |
| D1120 |
Prophylaxis - child |
10,073 |
10,035 |
$356K |
| D3310 |
|
1,040 |
712 |
$311K |
| D7240 |
Removal of impacted tooth - completely bony |
796 |
423 |
$182K |
| D9430 |
|
5,282 |
5,181 |
$167K |
| D7230 |
|
881 |
540 |
$165K |
| D1351 |
Sealant - per tooth |
5,020 |
1,472 |
$127K |
| D1110 |
Prophylaxis - adult |
1,420 |
1,413 |
$113K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,623 |
1,125 |
$107K |
| D0330 |
Panoramic radiographic image |
3,275 |
3,263 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,662 |
678 |
$95K |
| D1206 |
Topical application of fluoride varnish |
6,941 |
6,910 |
$94K |
| D0210 |
Intraoral - complete series of radiographic images |
1,207 |
1,205 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
4,632 |
4,594 |
$53K |
| D0272 |
Bitewings - two radiographic images |
4,279 |
4,263 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,443 |
5,432 |
$49K |
| D2160 |
|
498 |
364 |
$39K |
| D7220 |
|
260 |
165 |
$36K |
| D3348 |
|
77 |
72 |
$35K |
| D4341 |
|
406 |
145 |
$28K |
| D1310 |
|
602 |
602 |
$27K |
| D3351 |
|
180 |
165 |
$25K |
| D9993 |
|
333 |
333 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
338 |
202 |
$19K |
| D2954 |
|
158 |
125 |
$16K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
29 |
25 |
$14K |
| D0350 |
|
1,180 |
846 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
59 |
$5K |
| D2140 |
|
72 |
52 |
$4K |
| D3346 |
|
13 |
13 |
$4K |
| D4910 |
|
38 |
38 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
61 |
54 |
$2K |
| D2330 |
|
23 |
14 |
$2K |
| D0603 |
|
108 |
108 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
181 |
178 |
$460.00 |
| D0270 |
|
45 |
45 |
$225.00 |
| D0601 |
|
14 |
14 |
$210.00 |
| D1999 |
|
52 |
52 |
$0.00 |