| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
13,698 |
7,854 |
$6.51M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
8,723 |
6,973 |
$4.03M |
| D3320 |
|
5,774 |
4,237 |
$2.10M |
| D2954 |
|
19,409 |
11,378 |
$2.03M |
| D3310 |
|
6,126 |
2,999 |
$1.84M |
| D7140 |
Extraction, erupted tooth or exposed root |
30,428 |
9,358 |
$1.72M |
| D1110 |
Prophylaxis - adult |
18,935 |
18,893 |
$1.57M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
22,874 |
22,841 |
$1.44M |
| D4341 |
|
20,661 |
5,575 |
$1.42M |
| D0120 |
Periodic oral evaluation - established patient |
24,090 |
24,034 |
$1.40M |
| D1351 |
Sealant - per tooth |
49,388 |
10,452 |
$1.36M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,750 |
3,221 |
$1.15M |
| D1120 |
Prophylaxis - child |
28,688 |
28,636 |
$1.05M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
9,726 |
3,210 |
$963K |
| D9430 |
|
25,085 |
21,884 |
$796K |
| D2931 |
|
6,203 |
4,107 |
$774K |
| D0210 |
Intraoral - complete series of radiographic images |
16,399 |
16,374 |
$771K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,484 |
3,726 |
$763K |
| D0230 |
Intraoral - periapical each additional radiographic image |
145,036 |
32,638 |
$618K |
| D5130 |
|
840 |
838 |
$518K |
| D1206 |
Topical application of fluoride varnish |
27,441 |
27,388 |
$495K |
| D4342 |
|
9,666 |
3,145 |
$402K |
| D5140 |
|
593 |
593 |
$365K |
| D1310 |
|
7,455 |
7,436 |
$319K |
| D0274 |
Bitewings - four radiographic images |
13,112 |
13,087 |
$281K |
| D9993 |
|
4,599 |
4,592 |
$269K |
| D0220 |
Intraoral - periapical first radiographic image |
21,860 |
21,125 |
$260K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,188 |
20,160 |
$200K |
| D3348 |
|
392 |
355 |
$181K |
| D5211 |
|
417 |
417 |
$143K |
| D4910 |
|
1,787 |
1,782 |
$137K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,205 |
2,205 |
$128K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,563 |
2,489 |
$99K |
| D7230 |
|
531 |
455 |
$98K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,423 |
779 |
$95K |
| D0330 |
Panoramic radiographic image |
3,181 |
3,174 |
$93K |
| D0603 |
|
6,447 |
6,415 |
$91K |
| D5212 |
|
269 |
269 |
$91K |
| D2330 |
|
1,073 |
504 |
$82K |
| D5110 |
|
138 |
136 |
$81K |
| D5750 |
|
419 |
417 |
$81K |
| D9110 |
|
1,102 |
1,034 |
$67K |
| D1510 |
|
479 |
357 |
$60K |
| D0272 |
Bitewings - two radiographic images |
4,870 |
4,867 |
$57K |
| D3347 |
|
142 |
127 |
$52K |
| D1320 |
|
3,570 |
3,570 |
$50K |
| D3346 |
|
160 |
96 |
$48K |
| D5850 |
|
465 |
463 |
$32K |
| D5751 |
|
136 |
136 |
$26K |
| D5421 |
|
731 |
514 |
$25K |
| D5851 |
|
289 |
289 |
$20K |
| D5120 |
|
26 |
26 |
$15K |
| D2160 |
|
162 |
101 |
$13K |
| D5422 |
|
351 |
252 |
$12K |
| D0601 |
|
820 |
777 |
$9K |
| D1515 |
|
50 |
42 |
$9K |
| D7240 |
Removal of impacted tooth - completely bony |
30 |
25 |
$7K |
| D0350 |
|
401 |
318 |
$4K |
| D2140 |
|
73 |
52 |
$4K |
| D0602 |
|
87 |
75 |
$435.00 |
| D1354 |
|
178 |
41 |
$0.00 |