| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,564 |
5,223 |
$665K |
| D2740 |
Crown - porcelain/ceramic |
1,121 |
644 |
$558K |
| D0120 |
Periodic oral evaluation - established patient |
18,927 |
18,660 |
$454K |
| D1120 |
Prophylaxis - child |
12,794 |
12,648 |
$430K |
| D1110 |
Prophylaxis - adult |
9,000 |
8,836 |
$384K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,789 |
3,577 |
$336K |
| D1206 |
Topical application of fluoride varnish |
16,352 |
16,127 |
$335K |
| D8670 |
Periodic orthodontic treatment visit |
3,537 |
3,379 |
$324K |
| D7240 |
Removal of impacted tooth - completely bony |
1,156 |
397 |
$268K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,393 |
1,581 |
$191K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,767 |
738 |
$189K |
| D0274 |
Bitewings - four radiographic images |
7,330 |
7,189 |
$188K |
| D0330 |
Panoramic radiographic image |
4,237 |
4,166 |
$142K |
| D2950 |
|
1,214 |
823 |
$130K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,310 |
620 |
$113K |
| D0272 |
Bitewings - two radiographic images |
6,183 |
6,114 |
$110K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,865 |
4,794 |
$100K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
154 |
132 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,107 |
563 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,142 |
2,001 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,141 |
2,091 |
$60K |
| D9222 |
|
594 |
587 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
3,716 |
3,577 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,302 |
1,265 |
$28K |
| D7230 |
|
124 |
63 |
$25K |
| D8660 |
|
333 |
330 |
$16K |
| D1351 |
Sealant - per tooth |
415 |
162 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,729 |
802 |
$11K |
| D4346 |
|
232 |
225 |
$10K |
| D2332 |
|
113 |
68 |
$9K |
| D2335 |
|
77 |
40 |
$6K |
| D2330 |
|
85 |
64 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
81 |
76 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
46 |
44 |
$1K |
| D2331 |
|
15 |
12 |
$1K |