| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,482 |
1,876 |
$1.68M |
| D1110 |
Prophylaxis - adult |
23,613 |
23,605 |
$1.23M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,249 |
7,171 |
$950K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,541 |
1,370 |
$663K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,013 |
4,753 |
$652K |
| D0120 |
Periodic oral evaluation - established patient |
19,477 |
19,472 |
$521K |
| D2954 |
|
3,016 |
2,363 |
$510K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,181 |
3,366 |
$440K |
| D2394 |
|
2,363 |
1,946 |
$336K |
| D3320 |
|
945 |
828 |
$319K |
| D0330 |
Panoramic radiographic image |
9,283 |
9,275 |
$313K |
| D0274 |
Bitewings - four radiographic images |
12,039 |
12,032 |
$278K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,571 |
1,693 |
$253K |
| D7240 |
Removal of impacted tooth - completely bony |
541 |
345 |
$243K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,201 |
8,197 |
$243K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,734 |
2,806 |
$229K |
| D2335 |
|
1,266 |
899 |
$185K |
| D2332 |
|
1,296 |
896 |
$142K |
| D1120 |
Prophylaxis - child |
2,897 |
2,897 |
$123K |
| D3310 |
|
327 |
247 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
5,291 |
5,282 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,436 |
4,436 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,915 |
4,874 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
3,113 |
3,090 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,865 |
3,034 |
$34K |
| D2330 |
|
112 |
81 |
$7K |
| D0272 |
Bitewings - two radiographic images |
403 |
403 |
$6K |
| D1351 |
Sealant - per tooth |
39 |
37 |
$5K |
| D2331 |
|
40 |
38 |
$4K |
| D4341 |
|
34 |
12 |
$2K |
| D4910 |
|
12 |
12 |
$597.12 |
| D9996 |
|
43 |
42 |
$472.16 |