| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19,332 |
11,140 |
$1.49M |
| D1120 |
Prophylaxis - child |
39,174 |
37,928 |
$1.08M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16,883 |
10,587 |
$1.05M |
| D0120 |
Periodic oral evaluation - established patient |
53,555 |
51,947 |
$988K |
| D7240 |
Removal of impacted tooth - completely bony |
4,924 |
1,373 |
$966K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,894 |
4,584 |
$767K |
| D1208 |
Topical application of fluoride, excluding varnish |
49,304 |
47,864 |
$711K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32,386 |
29,405 |
$670K |
| D1999 |
|
35,589 |
33,569 |
$665K |
| D0330 |
Panoramic radiographic image |
14,447 |
13,821 |
$662K |
| D1110 |
Prophylaxis - adult |
17,983 |
17,453 |
$648K |
| D0240 |
|
33,446 |
16,139 |
$588K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,735 |
5,230 |
$464K |
| D0272 |
Bitewings - two radiographic images |
19,029 |
18,410 |
$337K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,757 |
2,571 |
$279K |
| D1206 |
Topical application of fluoride varnish |
11,484 |
10,877 |
$251K |
| D0274 |
Bitewings - four radiographic images |
10,633 |
10,266 |
$249K |
| D9222 |
|
1,757 |
1,645 |
$214K |
| D1351 |
Sealant - per tooth |
8,555 |
2,346 |
$204K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,199 |
1,483 |
$195K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,799 |
1,664 |
$190K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,619 |
7,186 |
$188K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
226 |
183 |
$125K |
| D2740 |
Crown - porcelain/ceramic |
257 |
129 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
3,168 |
2,990 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
5,705 |
5,331 |
$60K |
| D3240 |
|
331 |
243 |
$45K |
| D2330 |
|
728 |
488 |
$41K |
| D7230 |
|
235 |
91 |
$41K |
| D3230 |
|
308 |
136 |
$37K |
| D2332 |
|
327 |
202 |
$26K |
| D2950 |
|
253 |
148 |
$24K |
| D3120 |
|
1,036 |
732 |
$22K |
| D1354 |
|
619 |
250 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
530 |
412 |
$5K |
| D1510 |
|
26 |
26 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
149 |
142 |
$4K |
| D7911 |
|
48 |
47 |
$3K |
| D2335 |
|
13 |
12 |
$1K |
| D9310 |
|
33 |
29 |
$1K |