| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,372 |
7,308 |
$1.27M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,413 |
6,823 |
$897K |
| D8670 |
Periodic orthodontic treatment visit |
8,202 |
7,607 |
$815K |
| D1120 |
Prophylaxis - child |
27,333 |
25,248 |
$783K |
| D1351 |
Sealant - per tooth |
25,619 |
5,529 |
$653K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,333 |
1,631 |
$623K |
| D0120 |
Periodic oral evaluation - established patient |
17,646 |
16,310 |
$474K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,156 |
9,367 |
$389K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,800 |
17,514 |
$296K |
| D0330 |
Panoramic radiographic image |
7,362 |
6,788 |
$294K |
| D0274 |
Bitewings - four radiographic images |
11,119 |
10,377 |
$260K |
| D0272 |
Bitewings - two radiographic images |
12,698 |
11,664 |
$206K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
200 |
184 |
$205K |
| D1206 |
Topical application of fluoride varnish |
7,638 |
7,043 |
$200K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,742 |
6,630 |
$200K |
| D0220 |
Intraoral - periapical first radiographic image |
18,063 |
16,568 |
$190K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,170 |
782 |
$147K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,973 |
12,663 |
$133K |
| D0140 |
Limited oral evaluation - problem focused |
2,978 |
2,684 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
1,431 |
1,285 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,028 |
595 |
$69K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,130 |
402 |
$64K |
| D7240 |
Removal of impacted tooth - completely bony |
210 |
52 |
$33K |
| D2330 |
|
433 |
247 |
$24K |
| D1110 |
Prophylaxis - adult |
1,101 |
920 |
$23K |
| D0340 |
|
227 |
201 |
$13K |
| D0350 |
|
628 |
495 |
$11K |
| D2332 |
|
100 |
45 |
$10K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
163 |
119 |
$7K |
| D9222 |
|
166 |
121 |
$7K |
| D0270 |
|
39 |
28 |
$343.97 |
| D1999 |
|
2,642 |
2,366 |
$0.00 |