| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
4,452 |
3,030 |
$2.02M |
| D0120 |
Periodic oral evaluation - established patient |
23,703 |
23,420 |
$555K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,294 |
4,631 |
$439K |
| D1110 |
Prophylaxis - adult |
15,872 |
15,763 |
$390K |
| D0210 |
Intraoral - complete series of radiographic images |
10,291 |
10,240 |
$363K |
| D2750 |
|
707 |
519 |
$326K |
| D2954 |
|
3,272 |
2,425 |
$287K |
| D1120 |
Prophylaxis - child |
9,725 |
9,654 |
$284K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
732 |
561 |
$267K |
| D0140 |
Limited oral evaluation - problem focused |
10,938 |
10,557 |
$250K |
| D1351 |
Sealant - per tooth |
12,914 |
1,553 |
$235K |
| D1206 |
Topical application of fluoride varnish |
13,718 |
13,559 |
$219K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,882 |
8,835 |
$207K |
| D0274 |
Bitewings - four radiographic images |
13,735 |
13,667 |
$205K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,776 |
2,285 |
$202K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,931 |
1,392 |
$196K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,966 |
1,719 |
$160K |
| D0220 |
Intraoral - periapical first radiographic image |
25,623 |
25,061 |
$119K |
| D8670 |
Periodic orthodontic treatment visit |
3,906 |
3,552 |
$90K |
| D4341 |
|
1,970 |
653 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,705 |
18,401 |
$84K |
| D3320 |
|
234 |
187 |
$71K |
| D4910 |
|
1,408 |
1,400 |
$69K |
| D4346 |
|
1,882 |
1,882 |
$65K |
| D4355 |
|
844 |
843 |
$50K |
| D2952 |
|
420 |
339 |
$42K |
| D0330 |
Panoramic radiographic image |
1,504 |
1,493 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,311 |
3,283 |
$39K |
| D2335 |
|
481 |
320 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
641 |
332 |
$29K |
| D7240 |
Removal of impacted tooth - completely bony |
132 |
55 |
$29K |
| D0272 |
Bitewings - two radiographic images |
3,381 |
3,365 |
$27K |
| D2394 |
|
446 |
262 |
$27K |
| D2332 |
|
497 |
306 |
$27K |
| D2950 |
|
444 |
352 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,490 |
1,356 |
$23K |
| D2160 |
|
332 |
134 |
$18K |
| D2331 |
|
302 |
167 |
$14K |
| D9310 |
|
881 |
859 |
$14K |
| D1353 |
|
1,354 |
204 |
$14K |
| D7311 |
|
426 |
115 |
$11K |
| D9110 |
|
981 |
948 |
$10K |
| D5214 |
|
19 |
19 |
$10K |
| D7451 |
|
51 |
25 |
$8K |
| D2752 |
|
17 |
12 |
$8K |
| D2330 |
|
182 |
109 |
$8K |
| D1320 |
|
725 |
725 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
171 |
146 |
$7K |
| D5213 |
|
13 |
13 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
68 |
36 |
$7K |
| D5110 |
|
12 |
12 |
$6K |
| D3310 |
|
17 |
12 |
$4K |
| D0240 |
|
217 |
169 |
$3K |
| D0603 |
|
266 |
265 |
$3K |
| D2940 |
|
201 |
177 |
$2K |
| D2920 |
|
176 |
152 |
$2K |
| D7261 |
|
62 |
41 |
$2K |
| D0270 |
|
343 |
339 |
$2K |
| D0601 |
|
58 |
58 |
$580.00 |
| D0602 |
|
49 |
49 |
$490.00 |
| D9920 |
|
14 |
13 |
$232.00 |
| D4265 |
|
190 |
59 |
$200.00 |
| D0431 |
|
251 |
235 |
$0.00 |
| D1999 |
|
85 |
84 |
$0.00 |