| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
856 |
549 |
$406K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,107 |
4,087 |
$258K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,671 |
1,646 |
$242K |
| D0120 |
Periodic oral evaluation - established patient |
4,196 |
4,158 |
$230K |
| D1120 |
Prophylaxis - child |
5,111 |
5,059 |
$203K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,313 |
6,618 |
$142K |
| D0210 |
Intraoral - complete series of radiographic images |
2,819 |
2,807 |
$133K |
| D4341 |
|
1,812 |
495 |
$126K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
231 |
186 |
$107K |
| D4260 |
|
202 |
55 |
$99K |
| D2954 |
|
874 |
547 |
$92K |
| D9430 |
|
2,818 |
2,689 |
$90K |
| D1110 |
Prophylaxis - adult |
933 |
932 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,551 |
810 |
$83K |
| D0350 |
|
7,520 |
3,075 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,078 |
491 |
$61K |
| D1351 |
Sealant - per tooth |
1,672 |
518 |
$60K |
| D4910 |
|
733 |
733 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,124 |
4,076 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
417 |
216 |
$50K |
| D0340 |
|
877 |
877 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
639 |
256 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,047 |
1,038 |
$42K |
| D0330 |
Panoramic radiographic image |
1,336 |
1,331 |
$40K |
| D1206 |
Topical application of fluoride varnish |
2,091 |
2,087 |
$31K |
| D2740 |
Crown - porcelain/ceramic |
65 |
39 |
$31K |
| D1320 |
|
2,031 |
2,011 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,366 |
1,362 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,451 |
2,414 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,026 |
1,979 |
$24K |
| D1310 |
|
491 |
484 |
$22K |
| D3320 |
|
50 |
39 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
223 |
138 |
$17K |
| D2160 |
|
177 |
94 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
78 |
39 |
$9K |
| D7240 |
Removal of impacted tooth - completely bony |
40 |
15 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
91 |
50 |
$9K |
| D0603 |
|
480 |
474 |
$7K |
| D3310 |
|
22 |
13 |
$7K |
| D1510 |
|
31 |
26 |
$6K |
| D4342 |
|
107 |
36 |
$4K |
| D2330 |
|
28 |
13 |
$2K |
| D2161 |
|
17 |
12 |
$1K |
| D2140 |
|
21 |
17 |
$1K |
| D0270 |
|
27 |
27 |
$135.00 |