| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,481 |
12,028 |
$1.09M |
| D2740 |
Crown - porcelain/ceramic |
3,191 |
2,812 |
$939K |
| D4341 |
|
3,937 |
2,384 |
$937K |
| D1120 |
Prophylaxis - child |
21,799 |
20,934 |
$895K |
| D0120 |
Periodic oral evaluation - established patient |
30,368 |
29,277 |
$848K |
| D1351 |
Sealant - per tooth |
9,546 |
6,057 |
$779K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,801 |
20,938 |
$567K |
| D1110 |
Prophylaxis - adult |
9,463 |
9,161 |
$414K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,230 |
4,451 |
$402K |
| D2950 |
|
5,775 |
5,019 |
$386K |
| D4342 |
|
1,746 |
1,259 |
$354K |
| D0274 |
Bitewings - four radiographic images |
18,198 |
17,630 |
$325K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,847 |
4,254 |
$306K |
| D0140 |
Limited oral evaluation - problem focused |
13,025 |
12,371 |
$230K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,900 |
9,486 |
$221K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,715 |
2,500 |
$219K |
| D9110 |
|
3,673 |
3,595 |
$200K |
| D2331 |
|
1,844 |
1,571 |
$157K |
| D8670 |
Periodic orthodontic treatment visit |
641 |
607 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,998 |
2,620 |
$135K |
| D2332 |
|
1,304 |
1,156 |
$127K |
| D0220 |
Intraoral - periapical first radiographic image |
18,088 |
16,754 |
$104K |
| D2750 |
|
394 |
324 |
$101K |
| D3310 |
|
542 |
466 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,284 |
9,385 |
$61K |
| D0330 |
Panoramic radiographic image |
3,043 |
2,905 |
$58K |
| D2920 |
|
890 |
714 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
2,707 |
2,450 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
494 |
453 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,457 |
2,333 |
$25K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
71 |
66 |
$14K |
| D2330 |
|
147 |
135 |
$11K |
| D8999 |
|
68 |
66 |
$3K |
| D1354 |
|
15 |
14 |
$608.85 |
| D8660 |
|
21 |
17 |
$78.95 |