| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,772 |
2,125 |
$1.32M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,720 |
5,763 |
$794K |
| D1110 |
Prophylaxis - adult |
11,414 |
11,267 |
$471K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
615 |
565 |
$381K |
| D0120 |
Periodic oral evaluation - established patient |
17,207 |
16,965 |
$359K |
| D2954 |
|
2,644 |
2,133 |
$298K |
| D1120 |
Prophylaxis - child |
8,978 |
8,861 |
$236K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,603 |
1,889 |
$227K |
| D0210 |
Intraoral - complete series of radiographic images |
3,607 |
3,601 |
$194K |
| D1351 |
Sealant - per tooth |
9,647 |
1,651 |
$188K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,144 |
1,739 |
$173K |
| D0220 |
Intraoral - periapical first radiographic image |
20,869 |
20,222 |
$141K |
| D0140 |
Limited oral evaluation - problem focused |
7,074 |
6,763 |
$138K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,967 |
8,847 |
$130K |
| D0274 |
Bitewings - four radiographic images |
6,409 |
6,282 |
$113K |
| D8670 |
Periodic orthodontic treatment visit |
2,331 |
2,054 |
$104K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,549 |
745 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,790 |
3,761 |
$87K |
| D0272 |
Bitewings - two radiographic images |
5,772 |
5,660 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,841 |
15,897 |
$62K |
| D0603 |
|
5,013 |
4,907 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,899 |
2,635 |
$38K |
| D0330 |
Panoramic radiographic image |
2,001 |
1,945 |
$37K |
| D7111 |
|
610 |
323 |
$33K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
70 |
57 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
279 |
205 |
$24K |
| D3320 |
|
38 |
36 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
255 |
185 |
$15K |
| D9310 |
|
636 |
624 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
240 |
125 |
$12K |
| D2331 |
|
98 |
70 |
$7K |
| D0270 |
|
971 |
949 |
$7K |
| D2330 |
|
120 |
51 |
$6K |
| D4341 |
|
28 |
12 |
$3K |
| D2335 |
|
25 |
12 |
$2K |
| D2332 |
|
21 |
12 |
$2K |
| D4910 |
|
26 |
26 |
$2K |
| D9920 |
|
47 |
47 |
$758.00 |
| D8660 |
|
20 |
14 |
$657.80 |
| D0602 |
|
43 |
43 |
$380.00 |
| D2920 |
|
18 |
12 |
$200.00 |