| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
536 |
462 |
$296K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,406 |
1,974 |
$233K |
| D1110 |
Prophylaxis - adult |
5,306 |
5,069 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
8,375 |
8,043 |
$192K |
| D2792 |
|
296 |
175 |
$146K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,478 |
7,181 |
$145K |
| D1120 |
Prophylaxis - child |
4,554 |
4,382 |
$142K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,124 |
1,283 |
$119K |
| D3310 |
|
267 |
129 |
$107K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,597 |
3,216 |
$99K |
| D0274 |
Bitewings - four radiographic images |
3,395 |
3,287 |
$87K |
| D0330 |
Panoramic radiographic image |
2,617 |
2,485 |
$80K |
| D2950 |
|
729 |
515 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,789 |
1,681 |
$45K |
| D0272 |
Bitewings - two radiographic images |
2,724 |
2,582 |
$44K |
| D2740 |
Crown - porcelain/ceramic |
66 |
43 |
$37K |
| D9110 |
|
839 |
784 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
455 |
345 |
$37K |
| D3320 |
|
69 |
58 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
694 |
372 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,289 |
2,172 |
$26K |
| D1206 |
Topical application of fluoride varnish |
819 |
806 |
$17K |
| D2394 |
|
116 |
99 |
$10K |
| D2331 |
|
117 |
78 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
560 |
304 |
$5K |
| D2335 |
|
48 |
26 |
$4K |
| D2332 |
|
45 |
28 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
40 |
$912.69 |
| D0210 |
Intraoral - complete series of radiographic images |
22 |
21 |
$890.96 |