| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
765 |
730 |
$352K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,172 |
521 |
$138K |
| D2740 |
Crown - porcelain/ceramic |
284 |
202 |
$133K |
| D9430 |
|
3,998 |
3,924 |
$127K |
| D3320 |
|
223 |
202 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,768 |
2,827 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,454 |
2,429 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
503 |
499 |
$32K |
| D1110 |
Prophylaxis - adult |
265 |
264 |
$23K |
| D3310 |
|
72 |
56 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
397 |
393 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
353 |
205 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
224 |
224 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
243 |
163 |
$16K |
| D0330 |
Panoramic radiographic image |
493 |
490 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
802 |
795 |
$10K |
| D1206 |
Topical application of fluoride varnish |
575 |
568 |
$9K |
| D4341 |
|
112 |
35 |
$8K |
| D4910 |
|
100 |
100 |
$8K |
| D0350 |
|
317 |
197 |
$3K |
| D1120 |
Prophylaxis - child |
57 |
57 |
$3K |
| D3351 |
|
19 |
17 |
$3K |