| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32,472 |
17,287 |
$2.35M |
| D1110 |
Prophylaxis - adult |
45,256 |
44,829 |
$2.20M |
| D7140 |
Extraction, erupted tooth or exposed root |
26,672 |
13,007 |
$2.17M |
| D0330 |
Panoramic radiographic image |
29,368 |
29,054 |
$2.14M |
| D1206 |
Topical application of fluoride varnish |
78,298 |
77,587 |
$1.99M |
| D0120 |
Periodic oral evaluation - established patient |
52,987 |
52,529 |
$1.60M |
| D0274 |
Bitewings - four radiographic images |
42,116 |
41,715 |
$1.52M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26,092 |
14,851 |
$1.41M |
| D1120 |
Prophylaxis - child |
36,745 |
36,420 |
$1.24M |
| D0140 |
Limited oral evaluation - problem focused |
36,482 |
35,229 |
$1.21M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,620 |
2,586 |
$1.20M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26,930 |
26,648 |
$1.03M |
| D1351 |
Sealant - per tooth |
29,420 |
6,178 |
$853K |
| D4341 |
|
3,779 |
1,064 |
$786K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
7,396 |
5,072 |
$743K |
| D0230 |
Intraoral - periapical each additional radiographic image |
79,106 |
29,348 |
$733K |
| D2331 |
|
7,904 |
4,521 |
$721K |
| D0220 |
Intraoral - periapical first radiographic image |
52,270 |
50,149 |
$689K |
| D0272 |
Bitewings - two radiographic images |
21,383 |
21,197 |
$644K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,931 |
4,498 |
$613K |
| D1330 |
|
17,025 |
16,873 |
$528K |
| D2330 |
|
7,517 |
4,245 |
$515K |
| D5212 |
|
806 |
798 |
$508K |
| D7250 |
|
2,409 |
1,154 |
$395K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,658 |
1,261 |
$342K |
| D2335 |
|
2,847 |
2,125 |
$336K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,288 |
2,351 |
$333K |
| D2332 |
|
2,997 |
2,105 |
$307K |
| D0240 |
|
9,942 |
5,122 |
$297K |
| D2140 |
|
3,374 |
2,259 |
$235K |
| D3320 |
|
691 |
665 |
$225K |
| D5211 |
|
417 |
416 |
$221K |
| D2160 |
|
1,999 |
1,649 |
$215K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,219 |
9,449 |
$188K |
| D5110 |
|
270 |
261 |
$184K |
| D2934 |
|
448 |
178 |
$119K |
| D7111 |
|
978 |
659 |
$89K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,852 |
1,841 |
$81K |
| D9310 |
|
1,395 |
1,366 |
$79K |
| D4355 |
|
1,661 |
1,635 |
$78K |
| D2394 |
|
523 |
458 |
$61K |
| D4910 |
|
744 |
738 |
$60K |
| D3221 |
|
545 |
254 |
$60K |
| D3310 |
|
178 |
156 |
$51K |
| D1510 |
|
240 |
164 |
$45K |
| D7240 |
Removal of impacted tooth - completely bony |
138 |
44 |
$41K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
70 |
68 |
$41K |
| D5130 |
|
38 |
38 |
$32K |
| D3230 |
|
192 |
80 |
$30K |
| D2161 |
|
150 |
133 |
$19K |
| D9243 |
|
146 |
48 |
$17K |
| D9420 |
|
1,065 |
1,042 |
$8K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
170 |
131 |
$6K |
| D9239 |
|
48 |
48 |
$6K |
| D1354 |
|
168 |
36 |
$5K |
| D9920 |
|
142 |
137 |
$3K |
| D2940 |
|
47 |
44 |
$2K |
| D9110 |
|
27 |
27 |
$1K |
| D9951 |
|
13 |
12 |
$57.64 |
| D0273 |
|
12 |
12 |
$0.00 |