| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20,896 |
7,788 |
$1.18M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,524 |
6,592 |
$887K |
| D1120 |
Prophylaxis - child |
18,352 |
18,340 |
$604K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,585 |
1,536 |
$587K |
| D0120 |
Periodic oral evaluation - established patient |
21,148 |
21,136 |
$479K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,810 |
1,314 |
$384K |
| D2335 |
|
3,088 |
995 |
$365K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,219 |
23,205 |
$277K |
| D0272 |
Bitewings - two radiographic images |
17,759 |
17,743 |
$248K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,884 |
3,487 |
$247K |
| D1110 |
Prophylaxis - adult |
5,280 |
5,278 |
$219K |
| D2332 |
|
1,662 |
714 |
$165K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,557 |
1,130 |
$114K |
| D8670 |
Periodic orthodontic treatment visit |
391 |
391 |
$110K |
| D2394 |
|
765 |
408 |
$86K |
| D2330 |
|
1,502 |
848 |
$70K |
| D0240 |
|
5,494 |
5,326 |
$69K |
| D1351 |
Sealant - per tooth |
1,576 |
747 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
7,372 |
7,343 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,626 |
1,624 |
$38K |
| D1354 |
|
857 |
304 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,560 |
1,542 |
$19K |
| D0274 |
Bitewings - four radiographic images |
798 |
798 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
686 |
685 |
$16K |
| D9110 |
|
829 |
815 |
$14K |
| D0340 |
|
198 |
198 |
$11K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
14 |
14 |
$7K |
| D0330 |
Panoramic radiographic image |
199 |
199 |
$7K |
| D0470 |
|
199 |
199 |
$7K |
| D2331 |
|
92 |
76 |
$6K |
| D8660 |
|
194 |
194 |
$6K |
| D1206 |
Topical application of fluoride varnish |
232 |
232 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
704 |
665 |
$4K |
| D0350 |
|
230 |
230 |
$3K |
| D9310 |
|
105 |
105 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
19 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
60 |
$2K |
| D2140 |
|
25 |
15 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
513 |
491 |
$0.00 |