| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,480 |
1,886 |
$1.17M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,195 |
3,697 |
$962K |
| D0120 |
Periodic oral evaluation - established patient |
16,074 |
16,018 |
$851K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,833 |
1,691 |
$841K |
| D1110 |
Prophylaxis - adult |
8,813 |
8,770 |
$737K |
| D1351 |
Sealant - per tooth |
23,663 |
5,699 |
$663K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,078 |
10,046 |
$632K |
| D1120 |
Prophylaxis - child |
15,593 |
15,543 |
$571K |
| D0230 |
Intraoral - periapical each additional radiographic image |
101,463 |
18,700 |
$406K |
| D4341 |
|
6,040 |
1,680 |
$405K |
| D0210 |
Intraoral - complete series of radiographic images |
6,775 |
6,757 |
$315K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,390 |
24,285 |
$313K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,367 |
2,567 |
$303K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,208 |
2,567 |
$279K |
| D7240 |
Removal of impacted tooth - completely bony |
1,209 |
495 |
$277K |
| D3320 |
|
733 |
642 |
$265K |
| D0274 |
Bitewings - four radiographic images |
11,212 |
11,165 |
$232K |
| D4910 |
|
2,888 |
2,881 |
$221K |
| D2954 |
|
1,852 |
1,476 |
$193K |
| D2160 |
|
2,019 |
1,432 |
$159K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,910 |
2,743 |
$114K |
| D1310 |
|
2,319 |
2,311 |
$106K |
| D9993 |
|
1,531 |
1,531 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
6,940 |
6,880 |
$81K |
| D9430 |
|
1,929 |
1,905 |
$61K |
| D4342 |
|
1,537 |
510 |
$61K |
| D4260 |
|
114 |
30 |
$56K |
| D0272 |
Bitewings - two radiographic images |
3,222 |
3,211 |
$37K |
| D3310 |
|
102 |
64 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
457 |
297 |
$28K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
290 |
187 |
$28K |
| D0330 |
Panoramic radiographic image |
891 |
890 |
$26K |
| D5211 |
|
67 |
67 |
$23K |
| D7230 |
|
110 |
64 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
175 |
120 |
$19K |
| D2140 |
|
343 |
215 |
$19K |
| D0603 |
|
858 |
858 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
165 |
165 |
$8K |
| D5130 |
|
12 |
12 |
$8K |
| D0601 |
|
466 |
466 |
$7K |
| D2161 |
|
74 |
66 |
$6K |
| D5750 |
|
25 |
25 |
$5K |
| D5212 |
|
13 |
13 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
46 |
$4K |
| D0350 |
|
353 |
229 |
$3K |
| D0602 |
|
216 |
216 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
24 |
$2K |
| D2330 |
|
22 |
13 |
$2K |
| D2951 |
|
12 |
12 |
$1K |