| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
60,595 |
59,723 |
$2.38M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34,494 |
19,433 |
$2.26M |
| D1351 |
Sealant - per tooth |
96,061 |
24,274 |
$2.25M |
| D0120 |
Periodic oral evaluation - established patient |
76,330 |
75,371 |
$1.93M |
| D1206 |
Topical application of fluoride varnish |
68,844 |
67,812 |
$1.67M |
| D1110 |
Prophylaxis - adult |
26,533 |
26,315 |
$1.22M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,690 |
9,967 |
$840K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,890 |
3,706 |
$813K |
| D7240 |
Removal of impacted tooth - completely bony |
1,592 |
638 |
$514K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26,225 |
25,239 |
$447K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,463 |
4,146 |
$396K |
| D0220 |
Intraoral - periapical first radiographic image |
80,726 |
78,705 |
$373K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
613 |
582 |
$356K |
| D0230 |
Intraoral - periapical each additional radiographic image |
101,203 |
73,876 |
$330K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
449 |
449 |
$316K |
| D0274 |
Bitewings - four radiographic images |
32,321 |
31,986 |
$310K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,035 |
1,073 |
$272K |
| D7230 |
|
1,026 |
571 |
$262K |
| D0210 |
Intraoral - complete series of radiographic images |
4,577 |
4,549 |
$224K |
| D8670 |
Periodic orthodontic treatment visit |
4,170 |
4,055 |
$219K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,304 |
8,222 |
$212K |
| D0603 |
|
29,067 |
28,547 |
$210K |
| D8680 |
|
167 |
166 |
$207K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,974 |
2,268 |
$207K |
| D0330 |
Panoramic radiographic image |
5,672 |
5,532 |
$196K |
| D0272 |
Bitewings - two radiographic images |
33,623 |
33,161 |
$196K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,126 |
1,639 |
$136K |
| D9222 |
|
1,785 |
1,622 |
$132K |
| D9310 |
|
7,652 |
7,461 |
$127K |
| D2932 |
|
962 |
424 |
$120K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
211 |
173 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,297 |
4,253 |
$98K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,784 |
1,063 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
5,019 |
4,928 |
$86K |
| D3320 |
|
151 |
138 |
$69K |
| D9920 |
|
4,368 |
4,170 |
$65K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,359 |
3,283 |
$57K |
| D2740 |
Crown - porcelain/ceramic |
89 |
70 |
$52K |
| D9420 |
|
165 |
160 |
$51K |
| D7250 |
|
505 |
190 |
$45K |
| D7111 |
|
871 |
554 |
$33K |
| D0340 |
|
1,417 |
1,416 |
$21K |
| D2330 |
|
399 |
253 |
$16K |
| D0601 |
|
1,933 |
1,898 |
$16K |
| D2950 |
|
238 |
169 |
$10K |
| D2954 |
|
76 |
61 |
$6K |
| D0602 |
|
494 |
485 |
$4K |
| D2332 |
|
64 |
43 |
$4K |
| D2335 |
|
39 |
30 |
$3K |
| D8660 |
|
78 |
78 |
$2K |
| D0350 |
|
2,087 |
2,011 |
$2K |
| D1354 |
|
105 |
16 |
$360.00 |
| D0270 |
|
40 |
40 |
$180.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
215 |
201 |
$166.00 |