| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
186 |
170 |
$86K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
88 |
69 |
$42K |
| D9430 |
|
1,152 |
1,123 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
516 |
511 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
496 |
490 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
182 |
100 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
283 |
133 |
$18K |
| D0330 |
Panoramic radiographic image |
557 |
557 |
$16K |
| D0274 |
Bitewings - four radiographic images |
724 |
711 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,610 |
1,047 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
118 |
117 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
36 |
$4K |
| D2954 |
|
35 |
25 |
$4K |
| D1110 |
Prophylaxis - adult |
41 |
41 |
$3K |
| D2332 |
|
38 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
112 |
110 |
$2K |
| D0350 |
|
190 |
174 |
$2K |
| D1320 |
|
105 |
105 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
137 |
135 |
$1K |
| D4910 |
|
16 |
16 |
$1K |
| D1120 |
Prophylaxis - child |
15 |
15 |
$635.00 |