| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,085 |
1,551 |
$943K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,532 |
1,331 |
$878K |
| D1110 |
Prophylaxis - adult |
11,635 |
11,598 |
$416K |
| D0120 |
Periodic oral evaluation - established patient |
16,130 |
16,071 |
$375K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,793 |
3,216 |
$373K |
| D8670 |
Periodic orthodontic treatment visit |
7,262 |
6,571 |
$371K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,208 |
1,984 |
$359K |
| D3320 |
|
467 |
401 |
$227K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,318 |
2,203 |
$224K |
| D1120 |
Prophylaxis - child |
8,628 |
8,592 |
$185K |
| D7240 |
Removal of impacted tooth - completely bony |
575 |
198 |
$170K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,900 |
3,889 |
$150K |
| D2950 |
|
2,078 |
1,500 |
$142K |
| D1351 |
Sealant - per tooth |
8,177 |
1,065 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
23,918 |
23,465 |
$130K |
| D0210 |
Intraoral - complete series of radiographic images |
3,322 |
3,320 |
$127K |
| D0274 |
Bitewings - four radiographic images |
9,847 |
9,810 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,315 |
19,377 |
$90K |
| D3348 |
|
134 |
120 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
5,597 |
5,431 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
985 |
435 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,477 |
8,445 |
$66K |
| D9310 |
|
1,939 |
1,899 |
$66K |
| D0330 |
Panoramic radiographic image |
4,042 |
4,007 |
$57K |
| D3310 |
|
136 |
100 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
513 |
418 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,081 |
1,950 |
$43K |
| D8660 |
|
919 |
907 |
$35K |
| D0272 |
Bitewings - two radiographic images |
4,298 |
4,286 |
$26K |
| D9920 |
|
822 |
784 |
$15K |
| D2335 |
|
117 |
83 |
$11K |
| D1206 |
Topical application of fluoride varnish |
447 |
444 |
$7K |
| D4341 |
|
35 |
12 |
$2K |
| D2940 |
|
49 |
40 |
$498.20 |
| D0270 |
|
68 |
67 |
$268.80 |
| D1999 |
|
232 |
214 |
$0.00 |