| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
7,262 |
6,906 |
$3.35M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24,051 |
12,142 |
$2.83M |
| D7240 |
Removal of impacted tooth - completely bony |
8,961 |
3,883 |
$2.05M |
| D2740 |
Crown - porcelain/ceramic |
2,866 |
2,236 |
$1.36M |
| D9430 |
|
40,001 |
39,801 |
$1.27M |
| D0330 |
Panoramic radiographic image |
32,512 |
32,425 |
$951K |
| D3320 |
|
2,513 |
2,321 |
$913K |
| D7230 |
|
3,876 |
2,540 |
$727K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,942 |
3,488 |
$560K |
| D3310 |
|
1,471 |
1,111 |
$444K |
| D7220 |
|
1,829 |
1,328 |
$254K |
| D2954 |
|
2,394 |
1,966 |
$250K |
| D0230 |
Intraoral - periapical each additional radiographic image |
40,217 |
22,790 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,839 |
1,836 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
1,054 |
1,053 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
1,140 |
1,138 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
699 |
486 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,396 |
1,395 |
$28K |
| D1110 |
Prophylaxis - adult |
285 |
285 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,235 |
1,225 |
$14K |
| D0270 |
|
2,670 |
2,663 |
$13K |
| D9610 |
|
706 |
706 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
109 |
$8K |
| D3221 |
|
131 |
129 |
$8K |
| D1120 |
Prophylaxis - child |
122 |
122 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
37 |
$4K |
| D7410 |
|
25 |
16 |
$4K |
| D2330 |
|
24 |
14 |
$2K |
| D4341 |
|
34 |
15 |
$2K |
| D0272 |
Bitewings - two radiographic images |
133 |
133 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
39 |
37 |
$2K |
| D7310 |
|
26 |
12 |
$630.00 |