| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,361 |
878 |
$648K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,112 |
807 |
$376K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,365 |
5,342 |
$344K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
722 |
621 |
$334K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,755 |
1,188 |
$326K |
| D7240 |
Removal of impacted tooth - completely bony |
1,250 |
527 |
$288K |
| D0210 |
Intraoral - complete series of radiographic images |
4,589 |
4,578 |
$215K |
| D7230 |
|
916 |
494 |
$173K |
| D0120 |
Periodic oral evaluation - established patient |
1,753 |
1,742 |
$138K |
| D1110 |
Prophylaxis - adult |
1,566 |
1,560 |
$135K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,706 |
794 |
$114K |
| D2954 |
|
1,060 |
687 |
$111K |
| D0330 |
Panoramic radiographic image |
3,661 |
3,641 |
$108K |
| D9222 |
|
804 |
803 |
$98K |
| D4910 |
|
1,105 |
1,098 |
$85K |
| D9430 |
|
2,176 |
2,135 |
$70K |
| D9610 |
|
1,475 |
800 |
$66K |
| D1120 |
Prophylaxis - child |
1,455 |
1,443 |
$65K |
| D4341 |
|
910 |
261 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,389 |
2,686 |
$61K |
| D3320 |
|
161 |
129 |
$59K |
| D1320 |
|
3,598 |
3,581 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,503 |
3,484 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
494 |
283 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,212 |
1,205 |
$26K |
| D4342 |
|
456 |
163 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
295 |
99 |
$17K |
| D3310 |
|
47 |
25 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,172 |
1,141 |
$14K |
| D0350 |
|
798 |
372 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
61 |
$7K |
| D3348 |
|
14 |
12 |
$6K |
| D1351 |
Sealant - per tooth |
251 |
64 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
110 |
109 |
$4K |
| D0272 |
Bitewings - two radiographic images |
124 |
124 |
$1K |