| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,130 |
1,093 |
$522K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
899 |
640 |
$425K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,962 |
4,942 |
$306K |
| D0210 |
Intraoral - complete series of radiographic images |
5,060 |
5,039 |
$236K |
| D0120 |
Periodic oral evaluation - established patient |
3,090 |
3,063 |
$150K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
995 |
552 |
$115K |
| D3320 |
|
281 |
252 |
$102K |
| D9430 |
|
2,989 |
2,757 |
$95K |
| D2952 |
|
800 |
584 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,364 |
4,213 |
$82K |
| D1120 |
Prophylaxis - child |
2,195 |
2,187 |
$78K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
779 |
456 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,328 |
2,316 |
$47K |
| D1110 |
Prophylaxis - adult |
525 |
519 |
$43K |
| D1206 |
Topical application of fluoride varnish |
2,604 |
2,596 |
$32K |
| D1320 |
|
1,686 |
1,671 |
$25K |
| D3310 |
|
78 |
55 |
$24K |
| D2160 |
|
71 |
56 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
350 |
344 |
$4K |
| D1351 |
Sealant - per tooth |
181 |
54 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
259 |
257 |
$3K |
| D0272 |
Bitewings - two radiographic images |
173 |
172 |
$2K |
| D2140 |
|
21 |
16 |
$1K |
| D4910 |
|
12 |
12 |
$924.00 |
| D9110 |
|
16 |
16 |
$882.00 |
| D0350 |
|
35 |
14 |
$132.00 |
| D1330 |
|
12 |
12 |
$0.00 |