| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
3,040 |
2,143 |
$1.59M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,144 |
915 |
$197K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
654 |
590 |
$185K |
| D0210 |
Intraoral - complete series of radiographic images |
4,502 |
4,487 |
$169K |
| D0120 |
Periodic oral evaluation - established patient |
6,708 |
6,698 |
$145K |
| D1110 |
Prophylaxis - adult |
5,361 |
5,347 |
$131K |
| D2954 |
|
1,772 |
1,273 |
$115K |
| D9222 |
|
596 |
587 |
$73K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
127 |
115 |
$63K |
| D7240 |
Removal of impacted tooth - completely bony |
230 |
80 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,709 |
1,702 |
$57K |
| D1120 |
Prophylaxis - child |
2,751 |
2,750 |
$56K |
| D7250 |
|
581 |
224 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
701 |
517 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,868 |
1,841 |
$38K |
| D9310 |
|
1,477 |
1,473 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
4,420 |
4,362 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,854 |
1,851 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,297 |
2,296 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,586 |
2,835 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
281 |
229 |
$13K |
| D3320 |
|
30 |
27 |
$9K |
| D0272 |
Bitewings - two radiographic images |
558 |
558 |
$4K |
| D0270 |
|
158 |
157 |
$678.60 |
| D9612 |
|
30 |
28 |
$26.00 |