| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,738 |
1,281 |
$827K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,051 |
954 |
$485K |
| D0120 |
Periodic oral evaluation - established patient |
6,296 |
6,283 |
$379K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,645 |
5,631 |
$362K |
| D1110 |
Prophylaxis - adult |
4,214 |
4,204 |
$354K |
| D4341 |
|
4,351 |
1,202 |
$302K |
| D7240 |
Removal of impacted tooth - completely bony |
1,299 |
504 |
$300K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,007 |
897 |
$238K |
| D1120 |
Prophylaxis - child |
5,309 |
5,292 |
$206K |
| D0210 |
Intraoral - complete series of radiographic images |
3,487 |
3,478 |
$162K |
| D4910 |
|
1,886 |
1,875 |
$144K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,019 |
1,441 |
$135K |
| D1351 |
Sealant - per tooth |
5,064 |
1,264 |
$130K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,911 |
9,885 |
$127K |
| D2954 |
|
1,203 |
913 |
$126K |
| D7230 |
|
660 |
390 |
$124K |
| D3320 |
|
331 |
298 |
$120K |
| D0274 |
Bitewings - four radiographic images |
4,826 |
4,814 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,076 |
761 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,022 |
7,780 |
$68K |
| D8670 |
Periodic orthodontic treatment visit |
234 |
232 |
$67K |
| D2140 |
|
1,131 |
771 |
$61K |
| D0330 |
Panoramic radiographic image |
1,530 |
1,525 |
$45K |
| D4342 |
|
1,058 |
364 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
764 |
518 |
$41K |
| D0350 |
|
4,126 |
2,478 |
$40K |
| D9430 |
|
845 |
834 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
419 |
237 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,822 |
1,795 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
413 |
413 |
$14K |
| D3310 |
|
44 |
24 |
$13K |
| D0272 |
Bitewings - two radiographic images |
874 |
873 |
$10K |
| D2160 |
|
118 |
100 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
139 |
139 |
$6K |
| D2931 |
|
39 |
37 |
$5K |
| D2330 |
|
48 |
38 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
35 |
$3K |