| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
6,718 |
4,925 |
$3.36M |
| D0210 |
Intraoral - complete series of radiographic images |
26,753 |
26,289 |
$1.08M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
10,000 |
3,591 |
$818K |
| D7240 |
Removal of impacted tooth - completely bony |
3,239 |
957 |
$750K |
| D1110 |
Prophylaxis - adult |
27,694 |
26,782 |
$683K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
9,183 |
2,593 |
$675K |
| D0120 |
Periodic oral evaluation - established patient |
23,239 |
22,540 |
$638K |
| D9222 |
|
3,148 |
2,592 |
$321K |
| D2740 |
Crown - porcelain/ceramic |
656 |
472 |
$310K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,568 |
8,197 |
$280K |
| D0140 |
Limited oral evaluation - problem focused |
9,366 |
8,851 |
$216K |
| D7250 |
|
2,405 |
829 |
$205K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
418 |
356 |
$187K |
| D9310 |
|
7,834 |
6,869 |
$165K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,975 |
1,666 |
$158K |
| D2954 |
|
1,424 |
1,081 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
30,373 |
28,148 |
$74K |
| D1120 |
Prophylaxis - child |
3,185 |
3,088 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98,969 |
22,323 |
$62K |
| D7230 |
|
246 |
141 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
972 |
575 |
$43K |
| D2950 |
|
673 |
486 |
$43K |
| D0274 |
Bitewings - four radiographic images |
19,428 |
18,331 |
$40K |
| D1351 |
Sealant - per tooth |
2,224 |
273 |
$34K |
| D7261 |
|
412 |
171 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
315 |
170 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,293 |
1,236 |
$14K |
| D8670 |
Periodic orthodontic treatment visit |
259 |
227 |
$10K |
| D0330 |
Panoramic radiographic image |
912 |
864 |
$8K |
| D3348 |
|
19 |
19 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
83 |
66 |
$5K |
| D0270 |
|
565 |
543 |
$3K |
| D9920 |
|
142 |
138 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,258 |
2,119 |
$2K |
| D3320 |
|
22 |
13 |
$2K |
| D4341 |
|
54 |
14 |
$2K |
| D4355 |
|
14 |
13 |
$748.00 |
| D0272 |
Bitewings - two radiographic images |
31 |
31 |
$196.00 |
| D9612 |
|
3,255 |
2,211 |
$6.00 |
| D0340 |
|
16 |
16 |
$0.00 |
| D0601 |
|
40 |
20 |
$0.00 |
| D0603 |
|
38 |
36 |
$0.00 |