| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,247 |
1,124 |
$1.07M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,773 |
1,890 |
$1.02M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,057 |
9,014 |
$609K |
| D3320 |
|
614 |
531 |
$436K |
| D0330 |
Panoramic radiographic image |
4,659 |
4,444 |
$304K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
239 |
191 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
9,964 |
7,720 |
$93K |
| D4341 |
|
1,578 |
640 |
$90K |
| D0272 |
Bitewings - two radiographic images |
4,536 |
4,090 |
$71K |
| D3310 |
|
122 |
79 |
$66K |
| D1120 |
Prophylaxis - child |
2,174 |
2,169 |
$59K |
| D1110 |
Prophylaxis - adult |
1,027 |
1,022 |
$54K |
| D7240 |
Removal of impacted tooth - completely bony |
113 |
48 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
1,893 |
1,888 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,996 |
7,067 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,800 |
1,793 |
$39K |
| D1206 |
Topical application of fluoride varnish |
3,257 |
3,250 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
782 |
587 |
$30K |
| D9310 |
|
1,916 |
1,900 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
471 |
347 |
$17K |
| D0274 |
Bitewings - four radiographic images |
1,519 |
1,514 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
142 |
45 |
$12K |
| D7250 |
|
33 |
13 |
$9K |
| D1351 |
Sealant - per tooth |
390 |
143 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
200 |
200 |
$9K |
| D9430 |
|
335 |
327 |
$5K |
| D7220 |
|
18 |
13 |
$5K |
| D1310 |
|
163 |
162 |
$2K |
| D9110 |
|
177 |
149 |
$2K |
| D0270 |
|
466 |
455 |
$1K |
| D4342 |
|
30 |
13 |
$1K |
| D0350 |
|
2,207 |
1,359 |
$398.40 |
| D4910 |
|
12 |
12 |
$220.08 |
| D0140 |
Limited oral evaluation - problem focused |
153 |
148 |
$105.00 |
| D0601 |
|
84 |
83 |
$36.00 |
| D0191 |
|
150 |
145 |
$0.00 |
| D9993 |
|
120 |
119 |
$0.00 |
| D2950 |
|
109 |
87 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
38 |
38 |
$0.00 |
| D1330 |
|
1,921 |
1,912 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
143 |
97 |
$0.00 |