| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,732 |
3,369 |
$390K |
| D1120 |
Prophylaxis - child |
9,088 |
8,982 |
$380K |
| D1110 |
Prophylaxis - adult |
7,548 |
7,494 |
$340K |
| D1351 |
Sealant - per tooth |
13,867 |
3,049 |
$328K |
| D0120 |
Periodic oral evaluation - established patient |
11,550 |
11,429 |
$303K |
| D2740 |
Crown - porcelain/ceramic |
492 |
343 |
$268K |
| D1206 |
Topical application of fluoride varnish |
10,321 |
10,194 |
$262K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,484 |
1,542 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,436 |
4,403 |
$110K |
| D0210 |
Intraoral - complete series of radiographic images |
2,104 |
2,090 |
$103K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,146 |
3,126 |
$79K |
| D0330 |
Panoramic radiographic image |
1,950 |
1,897 |
$57K |
| D8670 |
Periodic orthodontic treatment visit |
1,222 |
1,149 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,154 |
2,956 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
10,693 |
10,285 |
$51K |
| D0274 |
Bitewings - four radiographic images |
3,868 |
3,832 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,288 |
8,965 |
$41K |
| D0272 |
Bitewings - two radiographic images |
4,505 |
4,455 |
$29K |
| D9310 |
|
2,570 |
2,505 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
314 |
240 |
$25K |
| D0603 |
|
2,204 |
2,179 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
244 |
155 |
$15K |
| D2950 |
|
284 |
196 |
$14K |
| D0601 |
|
1,672 |
1,654 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
134 |
83 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
627 |
620 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D0340 |
|
241 |
228 |
$3K |
| D0602 |
|
282 |
276 |
$2K |
| D9920 |
|
72 |
69 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
67 |
66 |
$1K |
| D0350 |
|
324 |
306 |
$246.00 |
| D0270 |
|
24 |
24 |
$115.00 |
| D8660 |
|
160 |
154 |
$0.00 |