| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,634 |
1,538 |
$741K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,678 |
5,656 |
$342K |
| D0120 |
Periodic oral evaluation - established patient |
7,972 |
7,919 |
$329K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
647 |
554 |
$287K |
| D1120 |
Prophylaxis - child |
6,846 |
6,816 |
$201K |
| D3320 |
|
470 |
425 |
$164K |
| D1110 |
Prophylaxis - adult |
1,879 |
1,861 |
$143K |
| D0274 |
Bitewings - four radiographic images |
6,781 |
6,744 |
$119K |
| D0210 |
Intraoral - complete series of radiographic images |
2,738 |
2,723 |
$110K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,871 |
1,290 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,452 |
9,956 |
$83K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,433 |
1,134 |
$80K |
| D1206 |
Topical application of fluoride varnish |
6,143 |
6,112 |
$70K |
| D9430 |
|
2,374 |
2,351 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
917 |
742 |
$53K |
| D1351 |
Sealant - per tooth |
1,663 |
613 |
$34K |
| D0350 |
|
2,413 |
1,722 |
$22K |
| D2954 |
|
212 |
184 |
$20K |
| D4341 |
|
270 |
116 |
$16K |
| D2160 |
|
197 |
170 |
$14K |
| D2140 |
|
162 |
136 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
536 |
534 |
$6K |
| D3310 |
|
18 |
13 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
89 |
67 |
$4K |
| D0272 |
Bitewings - two radiographic images |
374 |
372 |
$4K |
| D0330 |
Panoramic radiographic image |
157 |
156 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
25 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$2K |
| D0270 |
|
91 |
68 |
$134.50 |