| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,219 |
881 |
$570K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,837 |
4,834 |
$308K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,486 |
1,383 |
$158K |
| D1120 |
Prophylaxis - child |
2,841 |
2,834 |
$136K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,200 |
586 |
$133K |
| D4341 |
|
1,990 |
557 |
$129K |
| D1351 |
Sealant - per tooth |
3,276 |
839 |
$115K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,949 |
5,619 |
$108K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
214 |
197 |
$96K |
| D2954 |
|
881 |
667 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,509 |
834 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
1,089 |
1,087 |
$69K |
| D3320 |
|
178 |
152 |
$62K |
| D0274 |
Bitewings - four radiographic images |
3,196 |
3,194 |
$62K |
| D1110 |
Prophylaxis - adult |
584 |
583 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,408 |
2,402 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
1,029 |
1,028 |
$42K |
| D4910 |
|
512 |
512 |
$37K |
| D9430 |
|
1,149 |
1,113 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
537 |
185 |
$30K |
| D0340 |
|
513 |
512 |
$25K |
| D1310 |
|
538 |
538 |
$23K |
| D9999 |
Unspecified adjunctive procedure, by report |
218 |
185 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
303 |
235 |
$23K |
| D7240 |
Removal of impacted tooth - completely bony |
89 |
34 |
$20K |
| D1320 |
|
1,269 |
1,268 |
$19K |
| D1206 |
Topical application of fluoride varnish |
977 |
976 |
$18K |
| D3310 |
|
62 |
44 |
$18K |
| D0350 |
|
1,832 |
848 |
$17K |
| D4342 |
|
361 |
116 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,323 |
1,235 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
273 |
258 |
$10K |
| D0272 |
Bitewings - two radiographic images |
992 |
987 |
$10K |
| D0330 |
Panoramic radiographic image |
344 |
343 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
132 |
132 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
154 |
154 |
$5K |
| D0601 |
|
275 |
275 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
26 |
15 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
26 |
15 |
$3K |
| D7111 |
|
28 |
15 |
$1K |
| D2330 |
|
14 |
12 |
$961.99 |
| D0603 |
|
38 |
38 |
$540.00 |