| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
4,066 |
3,793 |
$1.86M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,503 |
10,471 |
$683K |
| D2740 |
Crown - porcelain/ceramic |
1,280 |
1,059 |
$599K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,297 |
1,768 |
$386K |
| D0120 |
Periodic oral evaluation - established patient |
6,182 |
6,136 |
$338K |
| D0230 |
Intraoral - periapical each additional radiographic image |
61,478 |
14,634 |
$267K |
| D0274 |
Bitewings - four radiographic images |
11,126 |
11,077 |
$232K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,992 |
2,212 |
$195K |
| D1120 |
Prophylaxis - child |
3,737 |
3,704 |
$139K |
| D9430 |
|
3,869 |
3,781 |
$122K |
| D3320 |
|
290 |
256 |
$103K |
| D0210 |
Intraoral - complete series of radiographic images |
1,836 |
1,829 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,002 |
837 |
$78K |
| D7240 |
Removal of impacted tooth - completely bony |
290 |
125 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,190 |
886 |
$63K |
| D1206 |
Topical application of fluoride varnish |
4,472 |
4,437 |
$58K |
| D2954 |
|
522 |
434 |
$54K |
| D1110 |
Prophylaxis - adult |
611 |
610 |
$52K |
| D1351 |
Sealant - per tooth |
1,442 |
396 |
$41K |
| D4341 |
|
527 |
207 |
$36K |
| D3348 |
|
56 |
55 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,107 |
2,081 |
$25K |
| D4910 |
|
294 |
294 |
$22K |
| D0330 |
Panoramic radiographic image |
684 |
683 |
$20K |
| D3310 |
|
70 |
40 |
$20K |
| D0350 |
|
1,701 |
1,311 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,262 |
1,254 |
$15K |
| D7230 |
|
63 |
36 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
158 |
71 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
441 |
440 |
$5K |
| D9993 |
|
60 |
60 |
$4K |
| D7220 |
|
24 |
12 |
$3K |
| D1310 |
|
73 |
73 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$910.00 |
| D0270 |
|
157 |
155 |
$760.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
104 |
104 |
$46.00 |
| D1999 |
|
12 |
12 |
$0.00 |