| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
7,420 |
4,962 |
$6.21M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31,021 |
15,602 |
$5.44M |
| D7240 |
Removal of impacted tooth - completely bony |
6,773 |
4,144 |
$3.99M |
| D8670 |
Periodic orthodontic treatment visit |
14,839 |
14,579 |
$3.38M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22,826 |
15,931 |
$2.74M |
| D9243 |
|
9,768 |
9,737 |
$2.53M |
| D1110 |
Prophylaxis - adult |
37,569 |
37,568 |
$2.48M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
4,274 |
3,803 |
$2.09M |
| D2954 |
|
9,651 |
7,182 |
$1.94M |
| D0120 |
Periodic oral evaluation - established patient |
43,404 |
43,402 |
$1.43M |
| D0274 |
Bitewings - four radiographic images |
42,658 |
42,651 |
$1.43M |
| D7140 |
Extraction, erupted tooth or exposed root |
14,986 |
8,313 |
$1.31M |
| D0210 |
Intraoral - complete series of radiographic images |
31,528 |
31,371 |
$1.27M |
| D1120 |
Prophylaxis - child |
25,500 |
25,498 |
$1.26M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,373 |
3,798 |
$1.04M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30,907 |
30,904 |
$1.01M |
| D1351 |
Sealant - per tooth |
15,933 |
6,458 |
$980K |
| D9239 |
|
9,219 |
9,207 |
$907K |
| D3320 |
|
2,224 |
1,919 |
$844K |
| D0330 |
Panoramic radiographic image |
27,199 |
27,182 |
$842K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,222 |
7,035 |
$827K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,727 |
3,749 |
$648K |
| D0220 |
Intraoral - periapical first radiographic image |
38,645 |
38,366 |
$646K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,539 |
3,080 |
$578K |
| D1206 |
Topical application of fluoride varnish |
15,238 |
15,238 |
$539K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
555 |
554 |
$535K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,307 |
3,918 |
$524K |
| D3310 |
|
1,372 |
876 |
$507K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,101 |
24,029 |
$442K |
| D7230 |
|
1,121 |
985 |
$334K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,056 |
20,056 |
$314K |
| D0340 |
|
4,549 |
4,547 |
$287K |
| D7250 |
|
1,874 |
952 |
$213K |
| D0140 |
Limited oral evaluation - problem focused |
12,923 |
12,826 |
$205K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
565 |
564 |
$205K |
| D0272 |
Bitewings - two radiographic images |
8,006 |
7,994 |
$154K |
| D5110 |
|
206 |
206 |
$140K |
| D0350 |
|
11,738 |
11,726 |
$136K |
| D2394 |
|
755 |
631 |
$129K |
| D9310 |
|
1,164 |
1,164 |
$116K |
| D8680 |
|
553 |
553 |
$104K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
754 |
482 |
$83K |
| D5120 |
|
96 |
96 |
$65K |
| D9222 |
|
537 |
536 |
$58K |
| D2332 |
|
370 |
230 |
$54K |
| D4341 |
|
602 |
280 |
$43K |
| D9610 |
|
2,190 |
2,187 |
$39K |
| D2331 |
|
249 |
195 |
$32K |
| D0470 |
|
793 |
792 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
995 |
995 |
$31K |
| D2140 |
|
400 |
217 |
$27K |
| D0270 |
|
1,513 |
1,510 |
$24K |
| D0160 |
|
694 |
694 |
$24K |
| D2160 |
|
144 |
109 |
$19K |
| D2330 |
|
163 |
119 |
$13K |
| D9995 |
|
512 |
427 |
$11K |
| D2335 |
|
47 |
35 |
$11K |
| D2740 |
Crown - porcelain/ceramic |
12 |
12 |
$10K |
| D9990 |
|
144 |
138 |
$3K |
| D0273 |
|
73 |
73 |
$2K |
| D7111 |
|
14 |
12 |
$788.72 |
| D9110 |
|
12 |
12 |
$319.00 |
| D9920 |
|
117 |
114 |
$0.00 |
| D9248 |
|
73 |
70 |
$0.00 |
| D9612 |
|
12 |
12 |
$0.00 |