| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,310 |
1,661 |
$1.21M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,352 |
997 |
$220K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
476 |
470 |
$140K |
| D1110 |
Prophylaxis - adult |
5,415 |
5,404 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
5,665 |
5,654 |
$123K |
| D2954 |
|
1,615 |
1,157 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
2,243 |
2,239 |
$84K |
| D7250 |
|
591 |
217 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
2,752 |
2,709 |
$56K |
| D9222 |
|
424 |
422 |
$53K |
| D9310 |
|
1,963 |
1,931 |
$48K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
78 |
66 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,539 |
4,700 |
$36K |
| D0274 |
Bitewings - four radiographic images |
2,876 |
2,874 |
$36K |
| D7240 |
Removal of impacted tooth - completely bony |
131 |
53 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
6,310 |
6,239 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
917 |
916 |
$31K |
| D3320 |
|
97 |
76 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
365 |
259 |
$20K |
| D1120 |
Prophylaxis - child |
816 |
815 |
$17K |
| D3310 |
|
42 |
30 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
111 |
77 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
565 |
565 |
$5K |
| D2332 |
|
39 |
28 |
$3K |
| D2335 |
|
30 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
106 |
103 |
$2K |
| D0330 |
Panoramic radiographic image |
93 |
93 |
$2K |
| D0270 |
|
368 |
366 |
$2K |
| D7261 |
|
16 |
16 |
$2K |
| D0272 |
Bitewings - two radiographic images |
209 |
208 |
$2K |