| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,395 |
2,204 |
$1.11M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,289 |
12,219 |
$800K |
| D7240 |
Removal of impacted tooth - completely bony |
2,508 |
1,116 |
$575K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,823 |
1,967 |
$453K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,924 |
1,141 |
$424K |
| D0350 |
|
40,368 |
10,194 |
$381K |
| D7230 |
|
1,381 |
723 |
$260K |
| D0330 |
Panoramic radiographic image |
6,456 |
6,434 |
$190K |
| D0230 |
Intraoral - periapical each additional radiographic image |
39,441 |
8,750 |
$161K |
| D9222 |
|
1,153 |
1,137 |
$141K |
| D0274 |
Bitewings - four radiographic images |
5,666 |
5,624 |
$121K |
| D1320 |
|
5,800 |
5,800 |
$89K |
| D3320 |
|
228 |
210 |
$83K |
| D9430 |
|
2,301 |
2,235 |
$74K |
| D9610 |
|
2,015 |
1,103 |
$69K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
54 |
45 |
$26K |
| D1120 |
Prophylaxis - child |
403 |
395 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
404 |
388 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
201 |
201 |
$14K |
| D9221 |
|
108 |
58 |
$12K |
| D3310 |
|
36 |
25 |
$11K |
| D9220 |
|
43 |
42 |
$8K |
| D3348 |
|
16 |
16 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
169 |
169 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
233 |
232 |
$3K |
| D0272 |
Bitewings - two radiographic images |
194 |
189 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
12 |
$2K |
| D0270 |
|
356 |
356 |
$2K |
| D3221 |
|
13 |
13 |
$819.00 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$672.00 |
| D1206 |
Topical application of fluoride varnish |
36 |
36 |
$386.00 |