| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
918 |
772 |
$310K |
| D2740 |
Crown - porcelain/ceramic |
1,329 |
526 |
$150K |
| D3320 |
|
560 |
425 |
$146K |
| D2950 |
|
2,094 |
1,238 |
$129K |
| D3310 |
|
256 |
99 |
$71K |
| D0330 |
Panoramic radiographic image |
1,468 |
1,453 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,011 |
609 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,429 |
1,425 |
$31K |
| D1110 |
Prophylaxis - adult |
1,329 |
1,324 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,967 |
1,925 |
$30K |
| D0274 |
Bitewings - four radiographic images |
2,041 |
2,023 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
4,338 |
3,797 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
533 |
285 |
$21K |
| D9310 |
|
458 |
447 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
104 |
56 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
464 |
315 |
$17K |
| D4355 |
|
222 |
219 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
683 |
387 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,987 |
1,898 |
$11K |
| D4341 |
|
923 |
233 |
$11K |
| D9920 |
|
221 |
215 |
$11K |
| D4342 |
|
212 |
54 |
$3K |
| D1120 |
Prophylaxis - child |
44 |
44 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
168 |
167 |
$2K |
| D0270 |
|
304 |
300 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
975 |
971 |
$917.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$314.40 |
| D4910 |
|
262 |
262 |
$0.00 |