| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,843 |
2,134 |
$1.70M |
| D1110 |
Prophylaxis - adult |
11,608 |
11,541 |
$552K |
| D0210 |
Intraoral - complete series of radiographic images |
8,383 |
8,336 |
$384K |
| D0120 |
Periodic oral evaluation - established patient |
12,018 |
11,949 |
$318K |
| D0140 |
Limited oral evaluation - problem focused |
7,313 |
7,144 |
$312K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,418 |
1,178 |
$287K |
| D2954 |
|
2,511 |
1,990 |
$266K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,191 |
2,021 |
$177K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,960 |
6,920 |
$161K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,111 |
7,067 |
$159K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
267 |
246 |
$152K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,766 |
1,096 |
$80K |
| D0274 |
Bitewings - four radiographic images |
5,770 |
5,752 |
$68K |
| D1120 |
Prophylaxis - child |
1,293 |
1,291 |
$61K |
| D1206 |
Topical application of fluoride varnish |
1,728 |
1,726 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
12,031 |
11,522 |
$57K |
| D4341 |
|
663 |
275 |
$49K |
| D4910 |
|
440 |
435 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,507 |
7,137 |
$37K |
| D0330 |
Panoramic radiographic image |
1,224 |
1,212 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
439 |
315 |
$29K |
| D1351 |
Sealant - per tooth |
1,212 |
178 |
$28K |
| D3320 |
|
63 |
55 |
$27K |
| D4355 |
|
195 |
194 |
$24K |
| D2335 |
|
148 |
91 |
$14K |
| D9310 |
|
559 |
554 |
$9K |
| D0180 |
|
153 |
151 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
411 |
376 |
$7K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
420 |
125 |
$6K |
| D2331 |
|
82 |
58 |
$6K |
| D2332 |
|
69 |
42 |
$6K |
| D3310 |
|
16 |
14 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
39 |
$4K |
| D0270 |
|
618 |
615 |
$3K |
| D2330 |
|
50 |
27 |
$3K |
| D9222 |
|
125 |
110 |
$2K |
| D2950 |
|
38 |
33 |
$2K |
| D9219 |
|
94 |
84 |
$315.37 |
| D9612 |
|
81 |
70 |
$2.00 |