| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
7,515 |
3,432 |
$7.98M |
| D6750 |
|
2,392 |
886 |
$2.45M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
344 |
343 |
$2.09M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,154 |
3,656 |
$1.76M |
| D7140 |
Extraction, erupted tooth or exposed root |
6,378 |
2,691 |
$1.61M |
| D6240 |
|
1,572 |
879 |
$1.44M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,062 |
3,587 |
$1.33M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,067 |
992 |
$1.22M |
| D2950 |
|
3,324 |
2,491 |
$1.06M |
| D3320 |
|
931 |
771 |
$931K |
| D5214 |
|
412 |
398 |
$885K |
| D2750 |
|
829 |
544 |
$857K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,109 |
6,995 |
$807K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,256 |
1,396 |
$675K |
| D1351 |
Sealant - per tooth |
9,474 |
1,690 |
$580K |
| D0210 |
Intraoral - complete series of radiographic images |
4,677 |
4,611 |
$580K |
| D1110 |
Prophylaxis - adult |
5,489 |
5,390 |
$576K |
| D0380 |
|
1,549 |
1,476 |
$445K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,426 |
582 |
$436K |
| D1120 |
Prophylaxis - child |
6,090 |
5,981 |
$434K |
| D3310 |
|
472 |
308 |
$434K |
| D0120 |
Periodic oral evaluation - established patient |
5,394 |
5,297 |
$388K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,376 |
951 |
$383K |
| D4341 |
|
1,314 |
473 |
$340K |
| D5213 |
|
161 |
155 |
$335K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,525 |
6,411 |
$330K |
| D0330 |
Panoramic radiographic image |
2,612 |
2,570 |
$326K |
| D0140 |
Limited oral evaluation - problem focused |
2,518 |
2,474 |
$302K |
| D0274 |
Bitewings - four radiographic images |
4,717 |
4,636 |
$289K |
| D1330 |
|
5,570 |
5,432 |
$271K |
| D4355 |
|
1,337 |
1,312 |
$250K |
| D0470 |
|
974 |
939 |
$173K |
| D8660 |
|
593 |
586 |
$171K |
| D9310 |
|
1,763 |
1,737 |
$162K |
| D2331 |
|
629 |
350 |
$157K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,100 |
1,073 |
$156K |
| D4910 |
|
764 |
748 |
$133K |
| D0220 |
Intraoral - periapical first radiographic image |
2,752 |
2,674 |
$101K |
| D5110 |
|
44 |
43 |
$87K |
| D4921 |
|
452 |
130 |
$65K |
| D2330 |
|
241 |
143 |
$47K |
| D0272 |
Bitewings - two radiographic images |
700 |
689 |
$30K |
| D6056 |
|
56 |
26 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,047 |
592 |
$25K |
| D7250 |
|
86 |
54 |
$21K |
| D9920 |
|
202 |
195 |
$20K |
| D0340 |
|
43 |
43 |
$6K |
| D2332 |
|
17 |
12 |
$5K |