| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
87,133 |
45,713 |
$2.97M |
| D1120 |
Prophylaxis - child |
97,976 |
96,954 |
$1.48M |
| D0120 |
Periodic oral evaluation - established patient |
144,552 |
143,191 |
$1.42M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38,126 |
23,566 |
$1.14M |
| D1208 |
Topical application of fluoride, excluding varnish |
132,827 |
131,573 |
$925K |
| D1110 |
Prophylaxis - adult |
51,479 |
50,999 |
$912K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17,927 |
7,435 |
$892K |
| D0220 |
Intraoral - periapical first radiographic image |
156,070 |
154,031 |
$780K |
| D0272 |
Bitewings - two radiographic images |
85,297 |
84,338 |
$679K |
| D0274 |
Bitewings - four radiographic images |
54,945 |
54,385 |
$635K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14,222 |
9,955 |
$558K |
| D0230 |
Intraoral - periapical each additional radiographic image |
112,723 |
106,279 |
$467K |
| D7140 |
Extraction, erupted tooth or exposed root |
12,162 |
6,644 |
$409K |
| D9222 |
|
3,028 |
2,955 |
$304K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
5,714 |
3,146 |
$281K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,142 |
1,964 |
$218K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21,899 |
20,954 |
$202K |
| D0330 |
Panoramic radiographic image |
8,791 |
8,721 |
$173K |
| D1351 |
Sealant - per tooth |
16,863 |
6,487 |
$164K |
| D1206 |
Topical application of fluoride varnish |
20,034 |
19,819 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,009 |
8,879 |
$158K |
| D9248 |
|
4,179 |
4,023 |
$122K |
| D2332 |
|
1,105 |
632 |
$46K |
| D7230 |
|
453 |
261 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
2,223 |
2,169 |
$32K |
| D2330 |
|
312 |
214 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
217 |
138 |
$9K |
| D7111 |
|
132 |
101 |
$4K |
| D2390 |
|
41 |
13 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
91 |
91 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
172 |
169 |
$2K |
| D2931 |
|
20 |
12 |
$1K |
| D7240 |
Removal of impacted tooth - completely bony |
22 |
13 |
$1K |
| D3120 |
|
48 |
42 |
$691.06 |
| D0602 |
|
6,652 |
6,242 |
$0.00 |
| D0603 |
|
3,352 |
3,003 |
$0.00 |
| D0601 |
|
1,852 |
1,709 |
$0.00 |
| D9920 |
|
15 |
13 |
$0.00 |