| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
5,509 |
3,863 |
$2.54M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,452 |
1,304 |
$861K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,651 |
5,437 |
$651K |
| D8670 |
Periodic orthodontic treatment visit |
10,030 |
9,574 |
$606K |
| D2954 |
|
4,983 |
3,646 |
$556K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,919 |
2,448 |
$498K |
| D1110 |
Prophylaxis - adult |
11,858 |
11,594 |
$455K |
| D1120 |
Prophylaxis - child |
15,134 |
14,894 |
$405K |
| D0120 |
Periodic oral evaluation - established patient |
20,165 |
19,769 |
$397K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
456 |
450 |
$391K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,631 |
21,417 |
$321K |
| D1351 |
Sealant - per tooth |
16,058 |
2,577 |
$304K |
| D0210 |
Intraoral - complete series of radiographic images |
5,089 |
5,086 |
$279K |
| D0330 |
Panoramic radiographic image |
8,360 |
8,212 |
$269K |
| D3320 |
|
534 |
432 |
$254K |
| D8680 |
|
219 |
207 |
$238K |
| D4341 |
|
3,132 |
911 |
$232K |
| D0140 |
Limited oral evaluation - problem focused |
11,292 |
10,858 |
$224K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,298 |
1,600 |
$221K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,119 |
1,507 |
$181K |
| D0274 |
Bitewings - four radiographic images |
8,613 |
8,320 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,867 |
4,803 |
$114K |
| D9310 |
|
4,225 |
4,136 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,877 |
1,097 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,567 |
1,053 |
$88K |
| D4910 |
|
1,206 |
1,164 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,790 |
4,186 |
$65K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
966 |
704 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
9,635 |
8,949 |
$58K |
| D0272 |
Bitewings - two radiographic images |
4,688 |
4,581 |
$54K |
| D2332 |
|
403 |
220 |
$33K |
| D8660 |
|
995 |
919 |
$25K |
| D7240 |
Removal of impacted tooth - completely bony |
68 |
25 |
$18K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
32 |
27 |
$15K |
| D2335 |
|
121 |
88 |
$12K |
| D1353 |
|
1,053 |
205 |
$11K |
| D3310 |
|
23 |
12 |
$10K |
| D0602 |
|
992 |
992 |
$10K |
| D1206 |
Topical application of fluoride varnish |
723 |
671 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,489 |
1,755 |
$8K |
| D2330 |
|
115 |
76 |
$6K |
| D4355 |
|
108 |
108 |
$5K |
| D7230 |
|
22 |
12 |
$4K |
| D9920 |
|
221 |
218 |
$4K |
| D0603 |
|
384 |
355 |
$3K |
| D0601 |
|
292 |
267 |
$3K |
| D2331 |
|
36 |
24 |
$2K |
| D2394 |
|
23 |
14 |
$1K |
| D9430 |
|
86 |
82 |
$1K |
| D0350 |
|
2,963 |
853 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
40 |
$585.00 |
| D2920 |
|
33 |
24 |
$435.00 |