| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
481 |
440 |
$545K |
| D2950 |
|
896 |
730 |
$221K |
| D9310 |
|
1,668 |
1,560 |
$180K |
| D3221 |
|
448 |
354 |
$122K |
| D3320 |
|
79 |
66 |
$75K |
| D1120 |
Prophylaxis - child |
743 |
728 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
283 |
260 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
364 |
354 |
$40K |
| D0330 |
Panoramic radiographic image |
348 |
334 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
371 |
367 |
$35K |
| D1206 |
Topical application of fluoride varnish |
793 |
776 |
$34K |
| D1351 |
Sealant - per tooth |
421 |
112 |
$25K |
| D0272 |
Bitewings - two radiographic images |
464 |
450 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
136 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
51 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
38 |
$11K |
| D0364 |
|
45 |
38 |
$8K |
| D0274 |
Bitewings - four radiographic images |
61 |
61 |
$4K |
| D0240 |
|
84 |
45 |
$3K |