| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
542 |
499 |
$218K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,444 |
801 |
$187K |
| D1206 |
Topical application of fluoride varnish |
6,484 |
6,132 |
$150K |
| D1351 |
Sealant - per tooth |
6,019 |
1,947 |
$125K |
| D8090 |
|
20 |
20 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
2,764 |
2,591 |
$69K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
306 |
89 |
$52K |
| D1120 |
Prophylaxis - child |
1,644 |
1,599 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
608 |
380 |
$47K |
| D9243 |
|
953 |
452 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
655 |
379 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
800 |
747 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,223 |
1,135 |
$33K |
| D7240 |
Removal of impacted tooth - completely bony |
146 |
56 |
$29K |
| D1110 |
Prophylaxis - adult |
805 |
735 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,097 |
1,040 |
$29K |
| D4341 |
|
257 |
126 |
$27K |
| D3320 |
|
94 |
81 |
$26K |
| D2740 |
Crown - porcelain/ceramic |
52 |
43 |
$25K |
| D0330 |
Panoramic radiographic image |
742 |
714 |
$22K |
| D7230 |
|
114 |
48 |
$19K |
| D9239 |
|
373 |
373 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
119 |
90 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
86 |
56 |
$10K |
| D2950 |
|
99 |
81 |
$10K |
| D2331 |
|
147 |
85 |
$10K |
| D0272 |
Bitewings - two radiographic images |
632 |
603 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,193 |
1,076 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
202 |
187 |
$9K |
| D0470 |
|
139 |
133 |
$8K |
| D0340 |
|
132 |
126 |
$8K |
| D0274 |
Bitewings - four radiographic images |
503 |
472 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,461 |
412 |
$7K |
| D2330 |
|
114 |
70 |
$7K |
| D3310 |
|
23 |
19 |
$6K |
| D0160 |
|
131 |
124 |
$5K |
| D4342 |
|
80 |
40 |
$4K |
| D4910 |
|
126 |
103 |
$4K |
| D9420 |
|
31 |
28 |
$3K |
| D1999 |
|
13 |
13 |
$130.00 |