| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
738 |
689 |
$276K |
| D0120 |
Periodic oral evaluation - established patient |
6,481 |
6,461 |
$145K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,251 |
1,700 |
$117K |
| D1120 |
Prophylaxis - child |
3,450 |
3,445 |
$114K |
| D0330 |
Panoramic radiographic image |
1,905 |
1,888 |
$90K |
| D8670 |
Periodic orthodontic treatment visit |
1,163 |
1,104 |
$87K |
| D1110 |
Prophylaxis - adult |
1,649 |
1,648 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
3,784 |
3,679 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,253 |
1,248 |
$49K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
276 |
137 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,066 |
777 |
$43K |
| D1206 |
Topical application of fluoride varnish |
7,154 |
7,129 |
$35K |
| D1351 |
Sealant - per tooth |
3,317 |
1,055 |
$35K |
| D7240 |
Removal of impacted tooth - completely bony |
174 |
64 |
$32K |
| D2950 |
|
934 |
830 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
379 |
324 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,123 |
1,111 |
$14K |
| D1354 |
|
2,002 |
585 |
$13K |
| D9999 |
Unspecified adjunctive procedure, by report |
579 |
579 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
850 |
809 |
$9K |
| D3221 |
|
182 |
173 |
$9K |
| D0272 |
Bitewings - two radiographic images |
2,893 |
2,887 |
$8K |
| D1330 |
|
7,194 |
7,179 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
104 |
76 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
2,176 |
2,138 |
$6K |
| D0240 |
|
1,070 |
1,049 |
$5K |
| D1999 |
|
81 |
81 |
$4K |
| D9310 |
|
163 |
162 |
$4K |
| D3310 |
|
15 |
12 |
$4K |
| D9248 |
|
46 |
45 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
80 |
79 |
$3K |
| D0274 |
Bitewings - four radiographic images |
449 |
448 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
320 |
320 |
$1K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
170 |
85 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
48 |
48 |
$960.00 |
| D9222 |
|
132 |
125 |
$639.96 |
| D2331 |
|
16 |
13 |
$519.85 |
| D9920 |
|
15 |
12 |
$392.37 |
| D0270 |
|
14 |
14 |
$8.00 |