| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
3,162 |
2,658 |
$1.29M |
| D2335 |
|
5,476 |
1,576 |
$646K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,350 |
2,249 |
$350K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,104 |
2,718 |
$346K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,080 |
3,248 |
$337K |
| D2740 |
Crown - porcelain/ceramic |
406 |
228 |
$316K |
| D1110 |
Prophylaxis - adult |
8,141 |
7,569 |
$281K |
| D3320 |
|
676 |
583 |
$227K |
| D0140 |
Limited oral evaluation - problem focused |
8,953 |
7,894 |
$212K |
| D2332 |
|
1,945 |
796 |
$194K |
| D0274 |
Bitewings - four radiographic images |
8,113 |
7,529 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
8,388 |
7,818 |
$147K |
| D0220 |
Intraoral - periapical first radiographic image |
16,735 |
14,685 |
$89K |
| D2394 |
|
1,065 |
825 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,584 |
2,392 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,914 |
8,509 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,690 |
3,429 |
$56K |
| D1120 |
Prophylaxis - child |
2,777 |
2,606 |
$53K |
| D2950 |
|
365 |
209 |
$47K |
| D0330 |
Panoramic radiographic image |
1,005 |
923 |
$47K |
| D2330 |
|
518 |
249 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
506 |
323 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
405 |
372 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,336 |
1,271 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
169 |
116 |
$9K |
| D3310 |
|
41 |
28 |
$9K |
| D2160 |
|
98 |
72 |
$6K |
| D2140 |
|
102 |
66 |
$4K |
| D2331 |
|
56 |
37 |
$3K |
| D9944 |
|
24 |
19 |
$2K |
| D2161 |
|
13 |
12 |
$995.02 |
| D1351 |
Sealant - per tooth |
49 |
12 |
$990.00 |
| D0470 |
|
23 |
19 |
$242.22 |
| D0270 |
|
57 |
45 |
$215.00 |