| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,814 |
4,134 |
$609K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,179 |
4,145 |
$499K |
| D0120 |
Periodic oral evaluation - established patient |
18,358 |
18,217 |
$493K |
| D1120 |
Prophylaxis - child |
18,296 |
18,108 |
$428K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
965 |
895 |
$330K |
| D1351 |
Sealant - per tooth |
13,346 |
3,381 |
$301K |
| D8670 |
Periodic orthodontic treatment visit |
1,557 |
1,456 |
$282K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,239 |
14,097 |
$246K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,224 |
5,122 |
$196K |
| D0220 |
Intraoral - periapical first radiographic image |
23,249 |
22,835 |
$186K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,281 |
593 |
$183K |
| D1110 |
Prophylaxis - adult |
4,412 |
4,365 |
$169K |
| D1206 |
Topical application of fluoride varnish |
6,349 |
6,280 |
$156K |
| D9999 |
Unspecified adjunctive procedure, by report |
4,693 |
4,652 |
$145K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,209 |
5,852 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
55,831 |
21,542 |
$128K |
| D0272 |
Bitewings - two radiographic images |
12,721 |
12,621 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,811 |
1,067 |
$102K |
| D0330 |
Panoramic radiographic image |
2,818 |
2,719 |
$96K |
| D0160 |
|
2,346 |
2,287 |
$91K |
| D9630 |
|
1,978 |
1,947 |
$84K |
| D2330 |
|
920 |
453 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
2,649 |
2,582 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
737 |
573 |
$53K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
652 |
372 |
$52K |
| D9920 |
|
1,608 |
1,562 |
$47K |
| D8660 |
|
126 |
118 |
$35K |
| D2331 |
|
388 |
221 |
$34K |
| D1999 |
|
2,472 |
2,310 |
$32K |
| D2332 |
|
203 |
119 |
$19K |
| D9248 |
|
334 |
323 |
$17K |
| D7240 |
Removal of impacted tooth - completely bony |
82 |
26 |
$12K |
| D7111 |
|
315 |
202 |
$9K |
| D8030 |
|
13 |
12 |
$3K |
| D0170 |
|
157 |
156 |
$1K |
| D9310 |
|
20 |
20 |
$0.00 |