| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
712 |
605 |
$383K |
| D2740 |
Crown - porcelain/ceramic |
852 |
520 |
$253K |
| D2950 |
|
812 |
607 |
$80K |
| D9310 |
|
888 |
748 |
$65K |
| D3320 |
|
122 |
100 |
$55K |
| D0330 |
Panoramic radiographic image |
1,329 |
1,081 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,077 |
582 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
625 |
377 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
448 |
171 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,981 |
1,818 |
$35K |
| D1110 |
Prophylaxis - adult |
811 |
793 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
3,587 |
3,042 |
$26K |
| D2394 |
|
181 |
121 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,268 |
1,256 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
1,129 |
923 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
821 |
816 |
$14K |
| D9994 |
|
2,278 |
2,236 |
$12K |
| D2931 |
|
80 |
60 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
378 |
200 |
$9K |
| D3310 |
|
23 |
12 |
$9K |
| D2954 |
|
180 |
116 |
$8K |
| D1206 |
Topical application of fluoride varnish |
458 |
451 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
704 |
633 |
$8K |
| D1120 |
Prophylaxis - child |
197 |
197 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
845 |
533 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
54 |
54 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$280.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
12 |
$0.00 |
| D9630 |
|
154 |
153 |
$0.00 |