| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
33,310 |
9,183 |
$931K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,763 |
7,292 |
$866K |
| D1120 |
Prophylaxis - child |
28,989 |
27,078 |
$769K |
| D0330 |
Panoramic radiographic image |
14,717 |
13,436 |
$647K |
| D0120 |
Periodic oral evaluation - established patient |
34,421 |
32,163 |
$611K |
| D1999 |
|
30,746 |
28,488 |
$573K |
| D1208 |
Topical application of fluoride, excluding varnish |
34,963 |
32,599 |
$476K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,284 |
4,421 |
$436K |
| D1351 |
Sealant - per tooth |
20,438 |
5,373 |
$435K |
| D0272 |
Bitewings - two radiographic images |
28,376 |
26,595 |
$412K |
| D1110 |
Prophylaxis - adult |
11,801 |
10,888 |
$402K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,444 |
10,467 |
$267K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,205 |
3,404 |
$261K |
| D0274 |
Bitewings - four radiographic images |
11,832 |
10,938 |
$225K |
| D2740 |
Crown - porcelain/ceramic |
625 |
325 |
$225K |
| D1206 |
Topical application of fluoride varnish |
9,513 |
8,845 |
$204K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,833 |
1,309 |
$163K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,461 |
1,100 |
$141K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
312 |
218 |
$132K |
| D0140 |
Limited oral evaluation - problem focused |
3,902 |
3,555 |
$100K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,621 |
3,203 |
$77K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
940 |
720 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
6,109 |
5,126 |
$56K |
| D2950 |
|
633 |
334 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
450 |
250 |
$22K |
| D3120 |
|
446 |
306 |
$9K |
| D7230 |
|
52 |
14 |
$9K |
| D2330 |
|
129 |
87 |
$7K |
| D2332 |
|
72 |
41 |
$6K |
| D9110 |
|
109 |
101 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
347 |
277 |
$3K |
| D2394 |
|
13 |
12 |
$2K |
| D9243 |
|
14 |
14 |
$2K |
| D2140 |
|
40 |
27 |
$2K |
| D2335 |
|
18 |
12 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
12 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
513 |
340 |
$0.00 |