| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,196 |
990 |
$551K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,607 |
1,555 |
$424K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,941 |
4,920 |
$320K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
576 |
384 |
$272K |
| D2740 |
Crown - porcelain/ceramic |
359 |
226 |
$171K |
| D0120 |
Periodic oral evaluation - established patient |
2,180 |
2,169 |
$144K |
| D0210 |
Intraoral - complete series of radiographic images |
3,032 |
3,021 |
$143K |
| D1110 |
Prophylaxis - adult |
1,367 |
1,360 |
$113K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,556 |
808 |
$104K |
| D1120 |
Prophylaxis - child |
2,271 |
2,257 |
$95K |
| D3320 |
|
240 |
191 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,954 |
4,328 |
$74K |
| D0274 |
Bitewings - four radiographic images |
2,654 |
2,640 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,814 |
3,790 |
$51K |
| D9430 |
|
1,423 |
1,278 |
$45K |
| D4341 |
|
518 |
145 |
$36K |
| D4910 |
|
419 |
416 |
$31K |
| D1351 |
Sealant - per tooth |
846 |
185 |
$26K |
| D2954 |
|
227 |
156 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
167 |
111 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
173 |
88 |
$11K |
| D2931 |
|
90 |
65 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
176 |
114 |
$10K |
| D0350 |
|
803 |
495 |
$9K |
| D3310 |
|
27 |
14 |
$8K |
| D0330 |
Panoramic radiographic image |
227 |
227 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
295 |
293 |
$4K |
| D0272 |
Bitewings - two radiographic images |
187 |
187 |
$2K |
| D2952 |
|
19 |
16 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$803.60 |
| D1310 |
|
12 |
12 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
34 |
33 |
$0.00 |
| D1999 |
|
67 |
63 |
$0.00 |
| D9993 |
|
12 |
12 |
$0.00 |