| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
791 |
728 |
$366K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,303 |
3,290 |
$213K |
| D0210 |
Intraoral - complete series of radiographic images |
3,202 |
3,189 |
$151K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
186 |
133 |
$89K |
| D3348 |
|
179 |
171 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
936 |
935 |
$52K |
| D1110 |
Prophylaxis - adult |
230 |
230 |
$20K |
| D0274 |
Bitewings - four radiographic images |
975 |
974 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
151 |
91 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,598 |
1,587 |
$17K |
| D4910 |
|
167 |
163 |
$13K |
| D2954 |
|
118 |
92 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,080 |
1,068 |
$8K |
| D3320 |
|
16 |
14 |
$6K |
| D1120 |
Prophylaxis - child |
122 |
122 |
$5K |
| D9430 |
|
144 |
142 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
13 |
$1K |