| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
7,328 |
3,396 |
$1.13M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,648 |
4,215 |
$939K |
| D1120 |
Prophylaxis - child |
21,366 |
20,953 |
$922K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,506 |
1,770 |
$866K |
| D1351 |
Sealant - per tooth |
25,615 |
7,832 |
$863K |
| D0120 |
Periodic oral evaluation - established patient |
28,443 |
27,909 |
$836K |
| D1206 |
Topical application of fluoride varnish |
32,845 |
32,233 |
$812K |
| D1110 |
Prophylaxis - adult |
10,285 |
10,112 |
$615K |
| D8670 |
Periodic orthodontic treatment visit |
4,377 |
4,271 |
$325K |
| D0274 |
Bitewings - four radiographic images |
14,465 |
14,196 |
$323K |
| D0330 |
Panoramic radiographic image |
6,195 |
6,073 |
$263K |
| D0272 |
Bitewings - two radiographic images |
13,104 |
12,847 |
$198K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,796 |
8,399 |
$161K |
| D7240 |
Removal of impacted tooth - completely bony |
584 |
163 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,207 |
2,166 |
$115K |
| D1330 |
|
18,292 |
17,928 |
$112K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
86 |
86 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
6,310 |
6,202 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
529 |
336 |
$58K |
| D9310 |
|
1,115 |
1,100 |
$53K |
| D2394 |
|
348 |
252 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
908 |
878 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
408 |
284 |
$39K |
| D8660 |
|
253 |
250 |
$37K |
| D3120 |
|
815 |
489 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,887 |
2,867 |
$21K |
| D9248 |
|
97 |
97 |
$18K |
| D9910 |
|
1,679 |
1,584 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
223 |
222 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
12 |
$2K |
| D7111 |
|
15 |
12 |
$405.00 |