| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,190 |
1,904 |
$1.00M |
| D2740 |
Crown - porcelain/ceramic |
1,572 |
1,176 |
$740K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,927 |
8,886 |
$575K |
| D0120 |
Periodic oral evaluation - established patient |
7,032 |
6,989 |
$428K |
| D1110 |
Prophylaxis - adult |
3,396 |
3,374 |
$286K |
| D1120 |
Prophylaxis - child |
6,987 |
6,945 |
$285K |
| D0230 |
Intraoral - periapical each additional radiographic image |
65,099 |
12,186 |
$267K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,250 |
2,055 |
$216K |
| D3320 |
|
530 |
459 |
$192K |
| D0274 |
Bitewings - four radiographic images |
8,678 |
8,609 |
$183K |
| D0210 |
Intraoral - complete series of radiographic images |
3,706 |
3,692 |
$175K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,526 |
1,591 |
$136K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,144 |
1,214 |
$122K |
| D9430 |
|
2,373 |
2,349 |
$75K |
| D4341 |
|
861 |
226 |
$60K |
| D4910 |
|
728 |
724 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,576 |
4,569 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,998 |
3,954 |
$48K |
| D0330 |
Panoramic radiographic image |
1,383 |
1,383 |
$41K |
| D2931 |
|
264 |
203 |
$33K |
| D0350 |
|
3,340 |
1,797 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
215 |
129 |
$26K |
| D3310 |
|
62 |
48 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
237 |
201 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,113 |
1,103 |
$13K |
| D3348 |
|
25 |
24 |
$12K |
| D7230 |
|
45 |
25 |
$9K |
| D2330 |
|
59 |
39 |
$5K |
| D2954 |
|
35 |
33 |
$4K |
| D1351 |
Sealant - per tooth |
72 |
19 |
$1K |