| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,693 |
5,395 |
$1.31M |
| D4342 |
|
6,653 |
2,396 |
$637K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,914 |
3,515 |
$618K |
| D2740 |
Crown - porcelain/ceramic |
1,001 |
797 |
$550K |
| D0120 |
Periodic oral evaluation - established patient |
20,027 |
19,704 |
$480K |
| D0220 |
Intraoral - periapical first radiographic image |
29,684 |
28,684 |
$373K |
| D4910 |
|
5,212 |
4,917 |
$364K |
| D4346 |
|
7,607 |
7,355 |
$348K |
| D1110 |
Prophylaxis - adult |
6,900 |
6,803 |
$328K |
| D0210 |
Intraoral - complete series of radiographic images |
4,437 |
4,330 |
$317K |
| D1120 |
Prophylaxis - child |
9,102 |
8,919 |
$313K |
| D1206 |
Topical application of fluoride varnish |
14,640 |
14,364 |
$286K |
| D0350 |
|
7,177 |
6,942 |
$233K |
| D0274 |
Bitewings - four radiographic images |
7,529 |
7,417 |
$223K |
| D0180 |
|
4,233 |
4,175 |
$179K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,453 |
9,273 |
$167K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
975 |
453 |
$159K |
| D9243 |
|
677 |
663 |
$148K |
| D0140 |
Limited oral evaluation - problem focused |
4,252 |
4,186 |
$147K |
| D8660 |
|
917 |
882 |
$128K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
578 |
406 |
$95K |
| D7240 |
Removal of impacted tooth - completely bony |
288 |
103 |
$79K |
| D0240 |
|
3,645 |
3,586 |
$72K |
| D9239 |
|
663 |
654 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,697 |
1,668 |
$67K |
| D1351 |
Sealant - per tooth |
1,873 |
659 |
$65K |
| D0340 |
|
885 |
853 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
457 |
232 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,828 |
1,786 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,095 |
1,019 |
$34K |
| D1354 |
|
587 |
105 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
349 |
104 |
$31K |
| D3120 |
|
719 |
305 |
$27K |
| D2330 |
|
234 |
120 |
$23K |
| D8670 |
Periodic orthodontic treatment visit |
156 |
150 |
$20K |
| D9310 |
|
465 |
460 |
$19K |
| D2332 |
|
122 |
75 |
$18K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$14K |
| D2950 |
|
107 |
89 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
90 |
42 |
$14K |
| D1353 |
|
336 |
123 |
$12K |
| D2991 |
|
173 |
32 |
$10K |
| D0330 |
Panoramic radiographic image |
176 |
174 |
$9K |
| D7230 |
|
28 |
15 |
$7K |
| D0460 |
|
158 |
157 |
$4K |
| D0380 |
|
28 |
28 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
94 |
94 |
$3K |
| D2331 |
|
19 |
13 |
$2K |
| D0160 |
|
21 |
21 |
$2K |
| D0470 |
|
14 |
14 |
$644.14 |