| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,193 |
1,634 |
$1.14M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
633 |
594 |
$313K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
516 |
507 |
$154K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,193 |
529 |
$111K |
| D1110 |
Prophylaxis - adult |
3,937 |
3,937 |
$97K |
| D0210 |
Intraoral - complete series of radiographic images |
1,981 |
1,978 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
3,395 |
3,394 |
$74K |
| D2954 |
|
988 |
723 |
$63K |
| D9222 |
|
502 |
495 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,285 |
1,284 |
$43K |
| D9310 |
|
1,552 |
1,533 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
439 |
317 |
$24K |
| D7240 |
Removal of impacted tooth - completely bony |
70 |
25 |
$19K |
| D0274 |
Bitewings - four radiographic images |
1,400 |
1,400 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
3,191 |
3,123 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
792 |
767 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,356 |
2,207 |
$11K |
| D1120 |
Prophylaxis - child |
456 |
456 |
$9K |
| D7250 |
|
91 |
43 |
$9K |
| D3320 |
|
18 |
17 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
55 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
415 |
415 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
14 |
$1K |
| D0270 |
|
142 |
141 |
$617.70 |
| D0272 |
Bitewings - two radiographic images |
70 |
70 |
$507.50 |