| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,231 |
1,453 |
$1.15M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,144 |
931 |
$551K |
| D1110 |
Prophylaxis - adult |
6,370 |
6,314 |
$217K |
| D3320 |
|
584 |
474 |
$211K |
| D2954 |
|
2,088 |
1,406 |
$199K |
| D1351 |
Sealant - per tooth |
8,322 |
1,219 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
5,377 |
5,332 |
$130K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,173 |
1,249 |
$123K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,747 |
1,042 |
$115K |
| D1206 |
Topical application of fluoride varnish |
4,390 |
4,372 |
$107K |
| D0330 |
Panoramic radiographic image |
4,423 |
4,363 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,063 |
4,029 |
$103K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,447 |
550 |
$100K |
| D0140 |
Limited oral evaluation - problem focused |
2,972 |
2,929 |
$98K |
| D1120 |
Prophylaxis - child |
2,914 |
2,893 |
$95K |
| D4341 |
|
1,799 |
590 |
$94K |
| D0210 |
Intraoral - complete series of radiographic images |
2,213 |
2,198 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,603 |
4,558 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,162 |
532 |
$64K |
| D0274 |
Bitewings - four radiographic images |
4,858 |
4,793 |
$48K |
| D9920 |
|
2,093 |
2,058 |
$42K |
| D4910 |
|
629 |
617 |
$41K |
| D7311 |
|
521 |
221 |
$40K |
| D2332 |
|
553 |
294 |
$32K |
| D3310 |
|
98 |
64 |
$28K |
| D4355 |
|
314 |
312 |
$27K |
| D2950 |
|
395 |
278 |
$24K |
| D2394 |
|
143 |
100 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,197 |
2,161 |
$11K |
| D0601 |
|
1,165 |
1,152 |
$10K |
| D7240 |
Removal of impacted tooth - completely bony |
42 |
14 |
$9K |
| D7911 |
|
162 |
127 |
$9K |
| D0602 |
|
644 |
640 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,200 |
861 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
69 |
$5K |
| D0272 |
Bitewings - two radiographic images |
410 |
408 |
$2K |
| D2335 |
|
24 |
14 |
$2K |
| D9944 |
|
27 |
26 |
$1K |
| D0603 |
|
116 |
116 |
$915.00 |
| D0170 |
|
31 |
29 |
$908.25 |
| D2161 |
|
14 |
12 |
$240.00 |
| D0270 |
|
25 |
25 |
$131.25 |
| D1330 |
|
806 |
785 |
$0.00 |