| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
5,729 |
3,191 |
$2.70M |
| D1110 |
Prophylaxis - adult |
6,816 |
6,784 |
$552K |
| D4341 |
|
7,393 |
2,073 |
$516K |
| D2954 |
|
4,694 |
2,732 |
$483K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,186 |
7,150 |
$472K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,020 |
2,507 |
$401K |
| D3320 |
|
1,015 |
822 |
$367K |
| D0210 |
Intraoral - complete series of radiographic images |
7,049 |
7,013 |
$329K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
690 |
617 |
$314K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,785 |
2,587 |
$312K |
| D3221 |
|
4,406 |
2,625 |
$256K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,154 |
1,282 |
$247K |
| D3310 |
|
737 |
363 |
$221K |
| D4910 |
|
2,833 |
2,821 |
$215K |
| D0350 |
|
25,324 |
6,849 |
$174K |
| D9430 |
|
5,260 |
4,561 |
$168K |
| D2330 |
|
2,095 |
1,093 |
$160K |
| D2931 |
|
1,138 |
781 |
$140K |
| D2952 |
|
1,150 |
793 |
$118K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,443 |
8,404 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
1,458 |
1,456 |
$111K |
| D4260 |
|
170 |
50 |
$83K |
| D5851 |
|
1,140 |
1,130 |
$79K |
| D9951 |
|
2,297 |
965 |
$77K |
| D5850 |
|
1,010 |
1,000 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
4,017 |
3,553 |
$48K |
| D4342 |
|
1,125 |
422 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,992 |
2,294 |
$29K |
| D1120 |
Prophylaxis - child |
731 |
729 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,234 |
1,232 |
$26K |
| D2932 |
|
162 |
110 |
$17K |
| D5761 |
|
82 |
82 |
$15K |
| D7230 |
|
86 |
71 |
$15K |
| D9910 |
|
263 |
226 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
175 |
122 |
$14K |
| D5760 |
|
46 |
45 |
$8K |
| D3348 |
|
12 |
12 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
26 |
$5K |
| D1351 |
Sealant - per tooth |
121 |
25 |
$4K |
| D2920 |
|
88 |
87 |
$4K |
| D5422 |
|
88 |
74 |
$3K |
| D6930 |
|
40 |
38 |
$3K |
| D2331 |
|
31 |
12 |
$3K |
| D5421 |
|
30 |
26 |
$910.00 |
| D1206 |
Topical application of fluoride varnish |
34 |
34 |
$612.00 |