| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
3,223 |
2,398 |
$1.77M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,518 |
9,113 |
$1.12M |
| D1120 |
Prophylaxis - child |
38,148 |
38,145 |
$1.03M |
| D0120 |
Periodic oral evaluation - established patient |
50,485 |
50,475 |
$1.01M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,571 |
2,513 |
$905K |
| D1110 |
Prophylaxis - adult |
18,282 |
18,280 |
$822K |
| D8680 |
|
660 |
660 |
$788K |
| D1351 |
Sealant - per tooth |
36,468 |
8,560 |
$729K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,273 |
7,174 |
$704K |
| D8670 |
Periodic orthodontic treatment visit |
10,446 |
10,037 |
$613K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
9,832 |
2,765 |
$574K |
| D9420 |
|
1,632 |
1,632 |
$519K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,507 |
3,715 |
$485K |
| D4341 |
|
4,708 |
1,563 |
$469K |
| D1206 |
Topical application of fluoride varnish |
44,797 |
44,785 |
$448K |
| D0230 |
Intraoral - periapical each additional radiographic image |
49,822 |
49,125 |
$437K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
699 |
626 |
$384K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
537 |
537 |
$382K |
| D0220 |
Intraoral - periapical first radiographic image |
54,143 |
53,038 |
$365K |
| D0210 |
Intraoral - complete series of radiographic images |
7,051 |
7,051 |
$330K |
| D0274 |
Bitewings - four radiographic images |
19,231 |
19,231 |
$311K |
| D2335 |
|
2,478 |
842 |
$240K |
| D0140 |
Limited oral evaluation - problem focused |
14,900 |
13,584 |
$223K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,867 |
1,962 |
$223K |
| D2950 |
|
2,673 |
1,992 |
$216K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,161 |
7,161 |
$215K |
| D0272 |
Bitewings - two radiographic images |
21,350 |
21,346 |
$192K |
| D2954 |
|
2,288 |
1,746 |
$183K |
| D3320 |
|
344 |
316 |
$146K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,638 |
687 |
$114K |
| D2330 |
|
1,580 |
804 |
$94K |
| D9310 |
|
3,065 |
3,040 |
$77K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,157 |
4,675 |
$74K |
| D3310 |
|
238 |
171 |
$71K |
| D2332 |
|
948 |
603 |
$71K |
| D2933 |
|
1,125 |
282 |
$71K |
| D0602 |
|
6,768 |
6,768 |
$68K |
| D0603 |
|
6,439 |
6,439 |
$64K |
| D8660 |
|
1,439 |
1,439 |
$64K |
| D0601 |
|
5,220 |
5,220 |
$52K |
| D2331 |
|
736 |
500 |
$51K |
| D7240 |
Removal of impacted tooth - completely bony |
133 |
49 |
$32K |
| D1510 |
|
254 |
204 |
$30K |
| D0330 |
Panoramic radiographic image |
1,037 |
1,037 |
$29K |
| D4910 |
|
807 |
807 |
$28K |
| D2394 |
|
319 |
238 |
$28K |
| D4346 |
|
682 |
682 |
$24K |
| D4355 |
|
446 |
446 |
$22K |
| D5110 |
|
38 |
38 |
$22K |
| D2932 |
|
331 |
111 |
$21K |
| D4342 |
|
308 |
173 |
$18K |
| D1320 |
|
860 |
860 |
$9K |
| D9110 |
|
530 |
516 |
$7K |
| D9920 |
|
396 |
363 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
350 |
350 |
$4K |
| D7250 |
|
56 |
27 |
$4K |
| D8692 |
|
14 |
14 |
$1K |
| D2920 |
|
44 |
41 |
$470.20 |
| D9999 |
Unspecified adjunctive procedure, by report |
93 |
93 |
$93.00 |
| D0350 |
|
12 |
12 |
$34.50 |
| D1999 |
|
102 |
100 |
$0.00 |