| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
4,630 |
3,432 |
$2.20M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
3,913 |
3,578 |
$1.81M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,284 |
13,222 |
$832K |
| D3320 |
|
2,138 |
1,810 |
$777K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14,362 |
7,269 |
$773K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,217 |
6,972 |
$746K |
| D0120 |
Periodic oral evaluation - established patient |
10,799 |
10,738 |
$648K |
| D0230 |
Intraoral - periapical each additional radiographic image |
142,530 |
24,060 |
$571K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,255 |
2,899 |
$501K |
| D4341 |
|
6,066 |
2,325 |
$416K |
| D2954 |
|
3,715 |
2,817 |
$389K |
| D3310 |
|
1,233 |
778 |
$371K |
| D1110 |
Prophylaxis - adult |
3,382 |
3,363 |
$280K |
| D0274 |
Bitewings - four radiographic images |
13,248 |
13,187 |
$279K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,300 |
2,731 |
$261K |
| D1120 |
Prophylaxis - child |
7,246 |
7,216 |
$258K |
| D9430 |
|
5,767 |
5,444 |
$182K |
| D0350 |
|
19,451 |
9,002 |
$176K |
| D9110 |
|
2,278 |
2,195 |
$143K |
| D1351 |
Sealant - per tooth |
5,369 |
1,511 |
$132K |
| D2330 |
|
1,701 |
1,115 |
$130K |
| D0272 |
Bitewings - two radiographic images |
10,570 |
10,512 |
$126K |
| D4910 |
|
1,680 |
1,672 |
$124K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,083 |
10,032 |
$110K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,694 |
922 |
$96K |
| D4342 |
|
1,701 |
759 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
5,782 |
5,409 |
$67K |
| D2335 |
|
342 |
252 |
$40K |
| D2394 |
|
396 |
353 |
$33K |
| D2332 |
|
319 |
240 |
$25K |
| D2931 |
|
97 |
76 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
64 |
64 |
$3K |