| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,502 |
1,434 |
$694K |
| D2740 |
Crown - porcelain/ceramic |
1,163 |
928 |
$553K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,479 |
7,445 |
$466K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
689 |
544 |
$328K |
| D2954 |
|
2,573 |
2,103 |
$266K |
| D0230 |
Intraoral - periapical each additional radiographic image |
59,748 |
10,788 |
$244K |
| D1110 |
Prophylaxis - adult |
2,755 |
2,741 |
$235K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,760 |
1,383 |
$207K |
| D3320 |
|
493 |
437 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
3,293 |
3,284 |
$170K |
| D4341 |
|
2,137 |
573 |
$146K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,131 |
1,336 |
$143K |
| D0272 |
Bitewings - two radiographic images |
9,789 |
9,752 |
$115K |
| D0220 |
Intraoral - periapical first radiographic image |
7,587 |
7,070 |
$90K |
| D9430 |
|
2,338 |
2,255 |
$74K |
| D3310 |
|
236 |
152 |
$71K |
| D2140 |
|
1,163 |
658 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,089 |
545 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,884 |
4,870 |
$62K |
| D2931 |
|
399 |
365 |
$50K |
| D1120 |
Prophylaxis - child |
1,373 |
1,372 |
$46K |
| D2160 |
|
164 |
135 |
$13K |
| D0350 |
|
1,357 |
796 |
$13K |
| D1351 |
Sealant - per tooth |
479 |
106 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
100 |
$4K |
| D2330 |
|
47 |
27 |
$4K |
| D4342 |
|
77 |
26 |
$3K |
| D0330 |
Panoramic radiographic image |
130 |
127 |
$3K |
| D0274 |
Bitewings - four radiographic images |
116 |
116 |
$2K |
| D2331 |
|
17 |
12 |
$1K |