| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
6,743 |
1,827 |
$7.77M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,775 |
2,543 |
$2.23M |
| D7240 |
Removal of impacted tooth - completely bony |
2,032 |
1,101 |
$1.44M |
| D1110 |
Prophylaxis - adult |
9,417 |
9,417 |
$625K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,735 |
1,731 |
$549K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,729 |
2,305 |
$540K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
480 |
454 |
$415K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,390 |
6,390 |
$314K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,426 |
796 |
$246K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,145 |
1,366 |
$237K |
| D3320 |
|
338 |
292 |
$231K |
| D0274 |
Bitewings - four radiographic images |
5,297 |
5,297 |
$226K |
| D0330 |
Panoramic radiographic image |
3,256 |
3,256 |
$225K |
| D1120 |
Prophylaxis - child |
4,259 |
4,259 |
$217K |
| D9222 |
|
1,597 |
1,594 |
$188K |
| D0120 |
Periodic oral evaluation - established patient |
5,733 |
5,733 |
$172K |
| D0210 |
Intraoral - complete series of radiographic images |
4,591 |
4,579 |
$167K |
| D0140 |
Limited oral evaluation - problem focused |
3,661 |
3,633 |
$159K |
| D3310 |
|
224 |
128 |
$125K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
619 |
494 |
$105K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
433 |
198 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
5,428 |
5,385 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,634 |
4,634 |
$64K |
| D1351 |
Sealant - per tooth |
1,376 |
402 |
$58K |
| D2954 |
|
260 |
180 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,761 |
1,759 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,475 |
1,474 |
$38K |
| D2335 |
|
179 |
100 |
$32K |
| D2330 |
|
280 |
162 |
$27K |
| D2331 |
|
175 |
134 |
$21K |
| D2332 |
|
116 |
72 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
437 |
412 |
$13K |
| D0272 |
Bitewings - two radiographic images |
463 |
463 |
$12K |
| D9310 |
|
150 |
150 |
$11K |
| D4910 |
|
137 |
137 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
69 |
46 |
$6K |
| D2394 |
|
15 |
13 |
$3K |
| D4342 |
|
28 |
13 |
$780.00 |
| D9430 |
|
58 |
57 |
$119.70 |
| D1999 |
|
16 |
16 |
$0.00 |
| D1330 |
|
28 |
28 |
$0.00 |