| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,744 |
1,836 |
$1.30M |
| D0120 |
Periodic oral evaluation - established patient |
16,637 |
16,553 |
$1.03M |
| D1120 |
Prophylaxis - child |
20,457 |
20,372 |
$858K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,830 |
3,221 |
$525K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,500 |
7,466 |
$490K |
| D0230 |
Intraoral - periapical each additional radiographic image |
110,848 |
21,305 |
$471K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
830 |
726 |
$384K |
| D1351 |
Sealant - per tooth |
11,145 |
2,892 |
$382K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,397 |
23,299 |
$359K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,428 |
1,304 |
$341K |
| D1310 |
|
5,888 |
5,867 |
$266K |
| D7111 |
|
4,588 |
2,257 |
$262K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,134 |
932 |
$255K |
| D2954 |
|
2,155 |
1,501 |
$226K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,794 |
774 |
$211K |
| D0272 |
Bitewings - two radiographic images |
16,584 |
16,526 |
$197K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,495 |
1,076 |
$167K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,053 |
1,170 |
$164K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,089 |
4,019 |
$162K |
| D4341 |
|
2,017 |
556 |
$138K |
| D9993 |
|
2,130 |
2,126 |
$132K |
| D0210 |
Intraoral - complete series of radiographic images |
2,696 |
2,675 |
$129K |
| D1110 |
Prophylaxis - adult |
1,343 |
1,340 |
$116K |
| D4910 |
|
1,291 |
1,286 |
$103K |
| D8670 |
Periodic orthodontic treatment visit |
357 |
356 |
$99K |
| D7240 |
Removal of impacted tooth - completely bony |
291 |
113 |
$67K |
| D0603 |
|
4,402 |
4,386 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,762 |
1,757 |
$59K |
| D0340 |
|
1,104 |
1,103 |
$55K |
| D0330 |
Panoramic radiographic image |
1,762 |
1,760 |
$51K |
| D0145 |
Oral evaluation for a patient under three years of age |
636 |
625 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,252 |
3,225 |
$39K |
| D9430 |
|
1,035 |
1,027 |
$32K |
| D2160 |
|
287 |
182 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
359 |
231 |
$20K |
| D3320 |
|
42 |
36 |
$15K |
| D7230 |
|
56 |
29 |
$11K |
| D4342 |
|
258 |
87 |
$10K |
| D0602 |
|
518 |
518 |
$8K |
| D2330 |
|
44 |
25 |
$3K |
| D1510 |
|
16 |
13 |
$3K |
| D2933 |
|
31 |
12 |
$3K |
| D0350 |
|
302 |
157 |
$3K |
| D2140 |
|
19 |
13 |
$1K |
| D5850 |
|
12 |
12 |
$840.00 |
| D0601 |
|
25 |
25 |
$375.00 |