| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
745 |
710 |
$341K |
| D2740 |
Crown - porcelain/ceramic |
429 |
358 |
$202K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,208 |
2,181 |
$144K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,364 |
2,675 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
527 |
312 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,201 |
2,198 |
$46K |
| D9430 |
|
1,406 |
1,383 |
$45K |
| D3320 |
|
97 |
92 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
347 |
347 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
356 |
208 |
$23K |
| D2954 |
|
163 |
139 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
310 |
309 |
$15K |
| D4341 |
|
138 |
41 |
$10K |
| D3310 |
|
27 |
22 |
$8K |
| D1206 |
Topical application of fluoride varnish |
457 |
452 |
$7K |
| D1110 |
Prophylaxis - adult |
80 |
80 |
$7K |
| D4910 |
|
79 |
79 |
$6K |
| D1120 |
Prophylaxis - child |
94 |
94 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
372 |
370 |
$4K |
| D0330 |
Panoramic radiographic image |
95 |
95 |
$3K |
| D0350 |
|
234 |
141 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
16 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$132.00 |