| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
6,165 |
4,281 |
$3.46M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28,403 |
15,898 |
$3.01M |
| D1110 |
Prophylaxis - adult |
38,325 |
38,173 |
$1.72M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
11,336 |
7,567 |
$1.40M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,305 |
2,157 |
$1.34M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
10,854 |
5,285 |
$1.28M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,719 |
9,971 |
$1.25M |
| D0120 |
Periodic oral evaluation - established patient |
48,758 |
48,603 |
$1.19M |
| D1351 |
Sealant - per tooth |
37,784 |
6,003 |
$1.10M |
| D7140 |
Extraction, erupted tooth or exposed root |
15,374 |
5,993 |
$1.09M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26,737 |
26,611 |
$988K |
| D1120 |
Prophylaxis - child |
25,282 |
25,233 |
$943K |
| D0210 |
Intraoral - complete series of radiographic images |
16,568 |
16,105 |
$918K |
| D2950 |
|
6,062 |
4,938 |
$854K |
| D0140 |
Limited oral evaluation - problem focused |
21,487 |
20,870 |
$836K |
| D5110 |
|
1,210 |
1,204 |
$827K |
| D0274 |
Bitewings - four radiographic images |
26,017 |
25,901 |
$752K |
| D0220 |
Intraoral - periapical first radiographic image |
53,532 |
52,536 |
$748K |
| D4341 |
|
5,930 |
2,233 |
$725K |
| D3320 |
|
1,621 |
1,429 |
$707K |
| D4342 |
|
6,181 |
2,197 |
$498K |
| D5120 |
|
705 |
705 |
$497K |
| D0230 |
Intraoral - periapical each additional radiographic image |
57,023 |
44,224 |
$472K |
| D2394 |
|
3,264 |
2,409 |
$469K |
| D5214 |
|
581 |
578 |
$462K |
| D2335 |
|
3,327 |
2,099 |
$431K |
| D1206 |
Topical application of fluoride varnish |
19,238 |
19,196 |
$416K |
| D3310 |
|
1,070 |
744 |
$409K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,546 |
22,442 |
$385K |
| D2332 |
|
3,498 |
2,281 |
$364K |
| D5213 |
|
432 |
430 |
$358K |
| D5225 |
|
418 |
416 |
$310K |
| D5226 |
|
405 |
403 |
$306K |
| D0330 |
Panoramic radiographic image |
5,356 |
5,305 |
$254K |
| D4910 |
|
4,153 |
4,098 |
$234K |
| D2330 |
|
3,254 |
1,967 |
$230K |
| D0272 |
Bitewings - two radiographic images |
8,325 |
8,294 |
$178K |
| D2790 |
|
291 |
243 |
$173K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
800 |
390 |
$151K |
| D2331 |
|
1,526 |
1,079 |
$134K |
| D2954 |
|
760 |
536 |
$128K |
| D4355 |
|
1,588 |
1,568 |
$118K |
| D7250 |
|
634 |
319 |
$104K |
| D4346 |
|
1,550 |
1,539 |
$94K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
832 |
238 |
$61K |
| D7240 |
Removal of impacted tooth - completely bony |
183 |
73 |
$48K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
337 |
229 |
$42K |
| D9222 |
|
275 |
227 |
$20K |
| D2710 |
|
28 |
25 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
458 |
457 |
$15K |
| D7111 |
|
226 |
153 |
$15K |
| D7310 |
|
95 |
41 |
$9K |
| D2940 |
|
89 |
83 |
$5K |
| D9248 |
|
31 |
28 |
$5K |
| D2920 |
|
93 |
90 |
$4K |
| D9310 |
|
60 |
60 |
$4K |
| D0270 |
|
441 |
436 |
$4K |
| D5750 |
|
13 |
13 |
$4K |
| D0240 |
|
167 |
86 |
$3K |
| D1330 |
|
126 |
115 |
$696.00 |
| D8660 |
|
373 |
361 |
$107.09 |
| D0431 |
|
1,119 |
1,117 |
$29.00 |
| D0340 |
|
367 |
357 |
$28.39 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
254 |
237 |
$22.40 |
| D0470 |
|
373 |
364 |
$0.00 |
| D0350 |
|
376 |
364 |
$0.00 |
| D1999 |
|
1,448 |
1,349 |
$0.00 |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
68 |
67 |
$0.00 |
| D8680 |
|
81 |
81 |
$0.00 |
| D9987 |
|
13 |
13 |
$0.00 |
| D9986 |
|
79 |
76 |
$0.00 |