| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,088 |
1,962 |
$961K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,622 |
1,253 |
$771K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,435 |
3,425 |
$221K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46,478 |
7,874 |
$188K |
| D2954 |
|
1,601 |
1,239 |
$168K |
| D3320 |
|
408 |
344 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
2,422 |
2,422 |
$123K |
| D9430 |
|
3,457 |
3,374 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,098 |
827 |
$73K |
| D0272 |
Bitewings - two radiographic images |
5,442 |
5,430 |
$64K |
| D1120 |
Prophylaxis - child |
1,753 |
1,753 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,861 |
4,732 |
$57K |
| D0350 |
|
3,994 |
2,382 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
584 |
406 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,491 |
2,491 |
$27K |
| D1110 |
Prophylaxis - adult |
256 |
256 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
96 |
51 |
$11K |
| D3221 |
|
120 |
103 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
67 |
$6K |
| D4341 |
|
31 |
13 |
$2K |
| D4910 |
|
26 |
26 |
$2K |
| D9993 |
|
13 |
13 |
$780.00 |
| D1310 |
|
13 |
13 |
$552.00 |
| D0601 |
|
13 |
13 |
$180.00 |