| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,618 |
4,598 |
$1.16M |
| D1110 |
Prophylaxis - adult |
15,847 |
15,333 |
$811K |
| D0120 |
Periodic oral evaluation - established patient |
24,634 |
23,946 |
$636K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,539 |
850 |
$607K |
| D1206 |
Topical application of fluoride varnish |
24,661 |
24,013 |
$524K |
| D1120 |
Prophylaxis - child |
10,691 |
10,447 |
$392K |
| D0140 |
Limited oral evaluation - problem focused |
9,755 |
9,425 |
$335K |
| D0274 |
Bitewings - four radiographic images |
8,845 |
8,568 |
$305K |
| D2740 |
Crown - porcelain/ceramic |
378 |
296 |
$242K |
| D0220 |
Intraoral - periapical first radiographic image |
14,403 |
13,605 |
$238K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,233 |
796 |
$217K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,845 |
1,694 |
$196K |
| D0330 |
Panoramic radiographic image |
3,392 |
3,297 |
$185K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,222 |
5,079 |
$183K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,532 |
854 |
$174K |
| D9248 |
|
1,021 |
965 |
$150K |
| D0210 |
Intraoral - complete series of radiographic images |
1,721 |
1,681 |
$115K |
| D2390 |
|
462 |
111 |
$101K |
| D2940 |
|
1,923 |
628 |
$95K |
| D0272 |
Bitewings - two radiographic images |
4,142 |
4,038 |
$88K |
| D1351 |
Sealant - per tooth |
3,056 |
969 |
$77K |
| D1310 |
|
1,887 |
1,853 |
$77K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,421 |
2,267 |
$73K |
| D2950 |
|
543 |
432 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,472 |
7,426 |
$68K |
| D1330 |
|
1,877 |
1,842 |
$45K |
| D0240 |
|
1,042 |
888 |
$19K |
| D0603 |
|
1,556 |
1,538 |
$17K |
| D2331 |
|
93 |
62 |
$9K |
| D0270 |
|
354 |
334 |
$6K |
| D1320 |
|
74 |
73 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
108 |
106 |
$2K |
| D2330 |
|
23 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
41 |
$1K |
| D4355 |
|
14 |
14 |
$1K |
| D1999 |
|
1,503 |
1,426 |
$1K |
| D1352 |
|
28 |
12 |
$790.40 |
| D9630 |
|
40 |
40 |
$668.30 |
| D8670 |
Periodic orthodontic treatment visit |
38 |
12 |
$460.00 |