| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,131 |
1,019 |
$502K |
| D1110 |
Prophylaxis - adult |
6,944 |
6,335 |
$315K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,403 |
4,696 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
7,455 |
7,123 |
$203K |
| D1120 |
Prophylaxis - child |
4,394 |
4,353 |
$155K |
| D2950 |
|
1,109 |
1,009 |
$134K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,733 |
1,008 |
$114K |
| D0210 |
Intraoral - complete series of radiographic images |
2,216 |
1,772 |
$111K |
| D2931 |
|
604 |
549 |
$101K |
| D0272 |
Bitewings - two radiographic images |
4,727 |
4,667 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,952 |
3,907 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
5,103 |
4,729 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
2,944 |
2,822 |
$51K |
| D1351 |
Sealant - per tooth |
1,820 |
594 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,036 |
1,725 |
$42K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
388 |
304 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,356 |
1,344 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,958 |
1,748 |
$20K |
| D3320 |
|
39 |
36 |
$15K |
| D0330 |
Panoramic radiographic image |
190 |
170 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
259 |
257 |
$11K |
| D2140 |
|
162 |
129 |
$10K |
| D2954 |
|
26 |
13 |
$4K |
| D0270 |
|
200 |
189 |
$773.37 |
| D9110 |
|
13 |
13 |
$0.00 |