| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
440 |
420 |
$204K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
358 |
330 |
$170K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,275 |
2,267 |
$145K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
964 |
577 |
$113K |
| D0210 |
Intraoral - complete series of radiographic images |
2,040 |
2,031 |
$96K |
| D9430 |
|
2,549 |
2,523 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
1,197 |
1,191 |
$76K |
| D1110 |
Prophylaxis - adult |
620 |
617 |
$54K |
| D3320 |
|
134 |
126 |
$49K |
| D4910 |
|
502 |
502 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
523 |
349 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,837 |
3,070 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,166 |
1,161 |
$24K |
| D0330 |
Panoramic radiographic image |
765 |
765 |
$23K |
| D2954 |
|
219 |
196 |
$23K |
| D1120 |
Prophylaxis - child |
375 |
372 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,280 |
1,267 |
$15K |
| D2140 |
|
150 |
99 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
650 |
649 |
$7K |
| D4341 |
|
97 |
28 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
15 |
$3K |
| D2160 |
|
16 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
103 |
103 |
$831.00 |
| D0350 |
|
28 |
26 |
$441.60 |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$288.00 |
| D1330 |
|
13 |
13 |
$0.00 |