| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
5,213 |
4,536 |
$2.41M |
| D2751 |
Crown - porcelain fused to predominantly base metal |
4,815 |
3,086 |
$2.29M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,645 |
11,572 |
$758K |
| D4341 |
|
9,077 |
2,498 |
$629K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,368 |
2,880 |
$621K |
| D2954 |
|
4,574 |
2,982 |
$479K |
| D3320 |
|
1,186 |
967 |
$433K |
| D4910 |
|
5,500 |
5,468 |
$421K |
| D3348 |
|
839 |
766 |
$389K |
| D9430 |
|
12,085 |
11,584 |
$386K |
| D0274 |
Bitewings - four radiographic images |
14,312 |
14,239 |
$304K |
| D3310 |
|
887 |
520 |
$268K |
| D0120 |
Periodic oral evaluation - established patient |
3,927 |
3,899 |
$253K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,563 |
1,983 |
$245K |
| D1110 |
Prophylaxis - adult |
2,159 |
2,150 |
$191K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,473 |
1,192 |
$164K |
| D0330 |
Panoramic radiographic image |
4,398 |
4,376 |
$130K |
| D1120 |
Prophylaxis - child |
2,620 |
2,596 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,318 |
18,445 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
8,959 |
8,266 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,027 |
4,972 |
$64K |
| D4342 |
|
1,521 |
565 |
$64K |
| D0350 |
|
4,601 |
1,567 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
711 |
328 |
$40K |
| D2330 |
|
507 |
210 |
$38K |
| D3347 |
|
62 |
56 |
$23K |
| D1320 |
|
1,275 |
1,275 |
$21K |
| D7230 |
|
92 |
56 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,458 |
1,450 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
228 |
228 |
$11K |
| D2740 |
Crown - porcelain/ceramic |
18 |
12 |
$9K |
| D7240 |
Removal of impacted tooth - completely bony |
24 |
12 |
$6K |
| D0270 |
|
672 |
672 |
$3K |
| D1206 |
Topical application of fluoride varnish |
85 |
84 |
$1K |
| D0250 |
|
13 |
13 |
$286.00 |
| D1310 |
|
412 |
412 |
$0.00 |
| D0602 |
|
276 |
276 |
$0.00 |