| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
4,095 |
3,699 |
$1.89M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14,399 |
6,207 |
$1.68M |
| D2740 |
Crown - porcelain/ceramic |
2,383 |
1,799 |
$1.13M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,164 |
16,117 |
$1.02M |
| D7240 |
Removal of impacted tooth - completely bony |
2,036 |
869 |
$466K |
| D0210 |
Intraoral - complete series of radiographic images |
7,308 |
7,277 |
$330K |
| D0120 |
Periodic oral evaluation - established patient |
6,139 |
6,117 |
$310K |
| D3320 |
|
635 |
561 |
$232K |
| D2954 |
|
2,110 |
1,662 |
$214K |
| D1110 |
Prophylaxis - adult |
2,342 |
2,328 |
$196K |
| D1120 |
Prophylaxis - child |
5,083 |
5,059 |
$196K |
| D7230 |
|
899 |
501 |
$169K |
| D0330 |
Panoramic radiographic image |
5,571 |
5,570 |
$165K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,917 |
7,298 |
$148K |
| D0274 |
Bitewings - four radiographic images |
4,691 |
4,673 |
$97K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,825 |
1,805 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,117 |
442 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
732 |
669 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,345 |
3,317 |
$55K |
| D1206 |
Topical application of fluoride varnish |
4,154 |
4,148 |
$48K |
| D3310 |
|
149 |
93 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
338 |
229 |
$22K |
| D1310 |
|
486 |
483 |
$22K |
| D1351 |
Sealant - per tooth |
986 |
168 |
$21K |
| D2394 |
|
224 |
206 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,404 |
1,404 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
501 |
501 |
$5K |
| D0601 |
|
314 |
314 |
$5K |
| D9993 |
|
228 |
228 |
$4K |
| D2952 |
|
20 |
15 |
$2K |
| D0602 |
|
12 |
12 |
$165.00 |
| D1999 |
|
148 |
146 |
$0.00 |