| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,239 |
1,523 |
$934K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
711 |
606 |
$349K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,498 |
2,149 |
$345K |
| D2954 |
|
2,616 |
1,713 |
$300K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,939 |
2,492 |
$264K |
| D0210 |
Intraoral - complete series of radiographic images |
5,633 |
5,494 |
$257K |
| D1110 |
Prophylaxis - adult |
5,464 |
5,347 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
9,270 |
9,131 |
$164K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,728 |
1,656 |
$139K |
| D3320 |
|
296 |
244 |
$119K |
| D1120 |
Prophylaxis - child |
4,594 |
4,551 |
$113K |
| D2740 |
Crown - porcelain/ceramic |
251 |
166 |
$113K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,849 |
7,719 |
$106K |
| D1351 |
Sealant - per tooth |
5,063 |
1,020 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
5,464 |
5,307 |
$90K |
| D4341 |
|
836 |
345 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,279 |
3,217 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
10,169 |
9,287 |
$59K |
| D3310 |
|
177 |
109 |
$56K |
| D0274 |
Bitewings - four radiographic images |
3,772 |
3,657 |
$54K |
| D0330 |
Panoramic radiographic image |
2,495 |
2,367 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
542 |
424 |
$44K |
| D7111 |
|
770 |
399 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
341 |
222 |
$33K |
| D4910 |
|
565 |
510 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,245 |
5,454 |
$26K |
| D9310 |
|
1,239 |
1,222 |
$23K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
353 |
222 |
$22K |
| D8670 |
Periodic orthodontic treatment visit |
473 |
403 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
456 |
178 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,549 |
1,549 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,370 |
1,279 |
$15K |
| D2335 |
|
152 |
81 |
$15K |
| D3348 |
|
29 |
24 |
$14K |
| D2330 |
|
194 |
95 |
$11K |
| D4355 |
|
201 |
201 |
$10K |
| D1206 |
Topical application of fluoride varnish |
1,050 |
1,034 |
$6K |
| D0270 |
|
758 |
718 |
$5K |
| D0602 |
|
385 |
385 |
$4K |
| D2332 |
|
42 |
30 |
$3K |
| D0603 |
|
184 |
184 |
$2K |
| D0350 |
|
438 |
438 |
$1K |
| D1353 |
|
33 |
13 |
$330.00 |
| D0171 |
|
29 |
28 |
$145.00 |
| D0601 |
|
13 |
12 |
$110.00 |
| D1999 |
|
180 |
171 |
$0.00 |