| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
77,152 |
37,447 |
$4.63M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
9,945 |
7,328 |
$4.21M |
| D7140 |
Extraction, erupted tooth or exposed root |
67,678 |
19,162 |
$4.15M |
| D2740 |
Crown - porcelain/ceramic |
5,024 |
2,690 |
$4.04M |
| D1110 |
Prophylaxis - adult |
93,098 |
83,514 |
$3.47M |
| D0330 |
Panoramic radiographic image |
51,329 |
44,089 |
$2.53M |
| D0140 |
Limited oral evaluation - problem focused |
98,236 |
83,255 |
$2.43M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32,737 |
18,559 |
$2.37M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
75,068 |
66,513 |
$2.13M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38,062 |
19,121 |
$2.12M |
| D0210 |
Intraoral - complete series of radiographic images |
39,286 |
33,057 |
$2.10M |
| D2954 |
|
15,570 |
8,440 |
$2.03M |
| D0120 |
Periodic oral evaluation - established patient |
100,886 |
88,789 |
$1.89M |
| D0274 |
Bitewings - four radiographic images |
90,630 |
79,903 |
$1.82M |
| D3320 |
|
5,408 |
3,750 |
$1.80M |
| D1206 |
Topical application of fluoride varnish |
88,823 |
76,545 |
$1.46M |
| D2931 |
|
11,844 |
6,897 |
$1.39M |
| D1120 |
Prophylaxis - child |
48,722 |
41,569 |
$1.06M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16,314 |
6,487 |
$1.06M |
| D4342 |
|
10,684 |
2,855 |
$853K |
| D2394 |
|
8,606 |
5,141 |
$720K |
| D0220 |
Intraoral - periapical first radiographic image |
128,886 |
111,524 |
$695K |
| D2335 |
|
6,635 |
3,184 |
$628K |
| D2950 |
|
4,882 |
3,456 |
$606K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98,751 |
59,951 |
$506K |
| D2332 |
|
6,121 |
3,316 |
$468K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,379 |
3,484 |
$340K |
| D7240 |
Removal of impacted tooth - completely bony |
1,928 |
617 |
$323K |
| D3310 |
|
841 |
428 |
$216K |
| D2160 |
|
3,105 |
1,933 |
$199K |
| D0272 |
Bitewings - two radiographic images |
15,806 |
13,202 |
$162K |
| D4910 |
|
3,140 |
2,914 |
$149K |
| D9944 |
|
497 |
441 |
$147K |
| D7230 |
|
978 |
506 |
$137K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
342 |
133 |
$134K |
| D5214 |
|
223 |
184 |
$120K |
| D5110 |
|
296 |
266 |
$115K |
| D8670 |
Periodic orthodontic treatment visit |
572 |
542 |
$98K |
| D2140 |
|
2,410 |
1,360 |
$95K |
| D2330 |
|
1,631 |
875 |
$88K |
| D2331 |
|
1,198 |
721 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,163 |
4,890 |
$73K |
| D4341 |
|
777 |
214 |
$67K |
| D5213 |
|
122 |
106 |
$59K |
| D0350 |
|
5,128 |
2,804 |
$58K |
| D1351 |
Sealant - per tooth |
2,264 |
513 |
$55K |
| D5120 |
|
97 |
88 |
$45K |
| D2161 |
|
579 |
403 |
$43K |
| D9243 |
|
640 |
221 |
$42K |
| D8030 |
|
495 |
479 |
$38K |
| D2752 |
|
52 |
26 |
$22K |
| D9239 |
|
712 |
292 |
$19K |
| D7310 |
|
202 |
78 |
$17K |
| D9110 |
|
430 |
420 |
$12K |
| D0340 |
|
291 |
286 |
$11K |
| D1320 |
|
289 |
284 |
$6K |
| D0240 |
|
224 |
97 |
$4K |
| D0470 |
|
167 |
162 |
$4K |
| D0270 |
|
340 |
293 |
$2K |
| D0180 |
|
16 |
15 |
$929.83 |
| D9995 |
|
280 |
245 |
$0.00 |
| D1330 |
|
26 |
13 |
$0.00 |
| D0701 |
|
95 |
92 |
$0.00 |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
42 |
29 |
$0.00 |
| D1999 |
|
86 |
84 |
$0.00 |
| D0431 |
|
14 |
14 |
$0.00 |