| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
445 |
434 |
$205K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,675 |
2,656 |
$175K |
| D0210 |
Intraoral - complete series of radiographic images |
1,839 |
1,826 |
$87K |
| D1110 |
Prophylaxis - adult |
946 |
941 |
$83K |
| D2740 |
Crown - porcelain/ceramic |
134 |
105 |
$63K |
| D9430 |
|
1,771 |
1,668 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
3,718 |
3,303 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,870 |
2,571 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
489 |
484 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,542 |
1,534 |
$24K |
| D3221 |
|
375 |
355 |
$23K |
| D1120 |
Prophylaxis - child |
402 |
401 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
173 |
158 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
106 |
74 |
$7K |
| D2140 |
|
117 |
104 |
$6K |
| D2940 |
|
99 |
81 |
$5K |
| D0350 |
|
463 |
187 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
32 |
$4K |
| D2160 |
|
14 |
14 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
44 |
44 |
$631.00 |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$540.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$144.00 |