| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
313 |
280 |
$198K |
| D2740 |
Crown - porcelain/ceramic |
392 |
289 |
$169K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
920 |
417 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,390 |
791 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
681 |
393 |
$78K |
| D2950 |
|
654 |
483 |
$68K |
| D9920 |
|
997 |
927 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
2,595 |
2,381 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,594 |
1,571 |
$44K |
| D1120 |
Prophylaxis - child |
1,364 |
1,361 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
2,314 |
2,292 |
$36K |
| D1110 |
Prophylaxis - adult |
1,082 |
1,066 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,421 |
1,406 |
$34K |
| D3320 |
|
56 |
45 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
949 |
858 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,467 |
1,463 |
$28K |
| D2750 |
|
36 |
27 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,470 |
1,412 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
201 |
107 |
$9K |
| D4341 |
|
133 |
44 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
753 |
454 |
$8K |
| D0330 |
Panoramic radiographic image |
171 |
152 |
$7K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$5K |
| D1206 |
Topical application of fluoride varnish |
188 |
187 |
$4K |
| D2331 |
|
26 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
86 |
86 |
$2K |
| D3120 |
|
79 |
54 |
$382.88 |
| D1999 |
|
15 |
15 |
$0.00 |
| D4910 |
|
15 |
15 |
$0.00 |
| D9994 |
|
343 |
320 |
$0.00 |
| D9630 |
|
199 |
175 |
$0.00 |