| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,634 |
1,362 |
$1.22M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,423 |
1,087 |
$291K |
| D3320 |
|
447 |
355 |
$246K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,942 |
3,800 |
$187K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,005 |
1,100 |
$106K |
| D1110 |
Prophylaxis - adult |
1,754 |
1,720 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
2,796 |
2,740 |
$91K |
| D4910 |
|
1,295 |
1,252 |
$87K |
| D1120 |
Prophylaxis - child |
1,714 |
1,667 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
5,192 |
5,012 |
$47K |
| D9999 |
Unspecified adjunctive procedure, by report |
382 |
357 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
489 |
335 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,455 |
1,453 |
$33K |
| D2740 |
Crown - porcelain/ceramic |
74 |
62 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
1,452 |
1,423 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
501 |
166 |
$28K |
| D0330 |
Panoramic radiographic image |
641 |
579 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,853 |
1,817 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,103 |
3,824 |
$17K |
| D1206 |
Topical application of fluoride varnish |
603 |
575 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
32 |
25 |
$13K |
| D0270 |
|
2,029 |
1,909 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
208 |
135 |
$8K |
| D4341 |
|
237 |
57 |
$7K |
| D9310 |
|
99 |
98 |
$5K |
| D1320 |
|
302 |
302 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
539 |
527 |
$1K |
| D2331 |
|
22 |
13 |
$1K |
| D2952 |
|
17 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
122 |
121 |
$902.00 |