| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,313 |
1,199 |
$608K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,009 |
6,983 |
$457K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,044 |
7,866 |
$136K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,341 |
340 |
$132K |
| D3348 |
|
228 |
210 |
$106K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
871 |
270 |
$104K |
| D1120 |
Prophylaxis - child |
2,787 |
2,772 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
1,603 |
1,592 |
$80K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
145 |
113 |
$69K |
| D3320 |
|
188 |
168 |
$68K |
| D0330 |
Panoramic radiographic image |
2,257 |
2,250 |
$67K |
| D7240 |
Removal of impacted tooth - completely bony |
279 |
117 |
$64K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
774 |
274 |
$51K |
| D1320 |
|
2,923 |
2,909 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,730 |
2,708 |
$37K |
| D8670 |
Periodic orthodontic treatment visit |
121 |
121 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
826 |
821 |
$33K |
| D1310 |
|
750 |
746 |
$31K |
| D9430 |
|
887 |
874 |
$28K |
| D2954 |
|
156 |
124 |
$16K |
| D3310 |
|
53 |
28 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
135 |
73 |
$16K |
| D9993 |
|
286 |
285 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
333 |
333 |
$16K |
| D7230 |
|
73 |
40 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,091 |
1,076 |
$13K |
| D0603 |
|
731 |
728 |
$10K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
92 |
38 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
98 |
$9K |
| D0274 |
Bitewings - four radiographic images |
443 |
428 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
210 |
210 |
$7K |
| D0272 |
Bitewings - two radiographic images |
465 |
461 |
$5K |
| D3999 |
|
115 |
107 |
$4K |
| D9222 |
|
37 |
37 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
82 |
26 |
$1K |
| D2140 |
|
22 |
13 |
$1K |
| D9248 |
|
12 |
12 |
$420.00 |
| D1330 |
|
17 |
17 |
$0.00 |