| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
852 |
794 |
$473K |
| D2740 |
Crown - porcelain/ceramic |
1,059 |
690 |
$328K |
| D1110 |
Prophylaxis - adult |
5,839 |
5,614 |
$216K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,937 |
2,011 |
$191K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,762 |
1,349 |
$141K |
| D1999 |
|
7,453 |
5,788 |
$137K |
| D7240 |
Removal of impacted tooth - completely bony |
516 |
143 |
$104K |
| D0330 |
Panoramic radiographic image |
2,226 |
2,142 |
$87K |
| D0274 |
Bitewings - four radiographic images |
3,576 |
3,435 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,232 |
5,024 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
3,563 |
3,437 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,404 |
2,294 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,424 |
1,339 |
$40K |
| D2950 |
|
494 |
327 |
$31K |
| D9222 |
|
189 |
171 |
$27K |
| D3120 |
|
943 |
801 |
$23K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
189 |
171 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,675 |
1,565 |
$18K |
| D2332 |
|
37 |
28 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
26 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
183 |
133 |
$2K |
| D9612 |
|
169 |
151 |
$1K |
| D2954 |
|
17 |
13 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
33 |
28 |
$725.40 |
| D9610 |
|
16 |
16 |
$144.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
79 |
53 |
$0.00 |