| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,326 |
1,213 |
$611K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
984 |
737 |
$468K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,618 |
3,596 |
$227K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,655 |
5,130 |
$150K |
| D2954 |
|
691 |
526 |
$72K |
| D2160 |
|
753 |
633 |
$59K |
| D0272 |
Bitewings - two radiographic images |
4,775 |
4,750 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,106 |
1,104 |
$51K |
| D3320 |
|
95 |
81 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
484 |
279 |
$31K |
| D1110 |
Prophylaxis - adult |
109 |
108 |
$8K |
| D1120 |
Prophylaxis - child |
251 |
248 |
$8K |
| D2140 |
|
166 |
72 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
120 |
120 |
$6K |
| D0350 |
|
604 |
235 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
410 |
408 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
25 |
$5K |
| D4341 |
|
54 |
14 |
$4K |
| D2330 |
|
33 |
13 |
$2K |
| D1320 |
|
104 |
104 |
$2K |
| D9430 |
|
43 |
42 |
$1K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$840.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$520.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$196.00 |
| D1330 |
|
16 |
16 |
$0.00 |