| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,520 |
6,170 |
$690K |
| D0120 |
Periodic oral evaluation - established patient |
25,912 |
25,407 |
$620K |
| D1110 |
Prophylaxis - adult |
13,938 |
13,602 |
$592K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,942 |
26,416 |
$554K |
| D1120 |
Prophylaxis - child |
15,461 |
15,224 |
$518K |
| D8670 |
Periodic orthodontic treatment visit |
4,315 |
3,922 |
$363K |
| D0274 |
Bitewings - four radiographic images |
10,195 |
9,967 |
$269K |
| D1351 |
Sealant - per tooth |
7,472 |
3,089 |
$226K |
| D0330 |
Panoramic radiographic image |
5,093 |
4,990 |
$207K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,667 |
1,410 |
$166K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,674 |
2,041 |
$165K |
| D0272 |
Bitewings - two radiographic images |
7,414 |
7,293 |
$131K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,015 |
3,657 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,839 |
2,783 |
$80K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
434 |
156 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,454 |
3,332 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
454 |
375 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,832 |
1,804 |
$37K |
| D1353 |
|
928 |
357 |
$25K |
| D2740 |
Crown - porcelain/ceramic |
48 |
40 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,570 |
1,288 |
$12K |
| D8660 |
|
290 |
282 |
$12K |
| D1354 |
|
363 |
173 |
$4K |
| D2950 |
|
21 |
16 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
86 |
86 |
$2K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
19 |
16 |
$2K |
| D9222 |
|
16 |
16 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
38 |
$854.98 |
| D9310 |
|
14 |
14 |
$371.00 |
| D9610 |
|
16 |
16 |
$331.07 |
| D3120 |
|
16 |
15 |
$64.00 |