| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
5,537 |
2,096 |
$975K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,132 |
2,203 |
$954K |
| D1120 |
Prophylaxis - child |
20,115 |
19,210 |
$932K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,531 |
3,605 |
$675K |
| D2332 |
|
4,339 |
2,382 |
$608K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,332 |
3,480 |
$577K |
| D0120 |
Periodic oral evaluation - established patient |
18,247 |
17,463 |
$523K |
| D1206 |
Topical application of fluoride varnish |
20,315 |
19,449 |
$512K |
| D8670 |
Periodic orthodontic treatment visit |
2,385 |
2,112 |
$495K |
| D1351 |
Sealant - per tooth |
10,329 |
3,449 |
$396K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,468 |
1,915 |
$335K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,159 |
8,084 |
$277K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,944 |
1,059 |
$196K |
| D0272 |
Bitewings - two radiographic images |
6,551 |
6,282 |
$189K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,816 |
2,686 |
$159K |
| D0274 |
Bitewings - four radiographic images |
2,457 |
2,347 |
$102K |
| D0140 |
Limited oral evaluation - problem focused |
2,180 |
2,010 |
$92K |
| D9110 |
|
1,218 |
1,138 |
$81K |
| D2394 |
|
373 |
295 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
3,385 |
3,206 |
$62K |
| D2160 |
|
459 |
327 |
$47K |
| D1517 |
|
139 |
136 |
$45K |
| D1110 |
Prophylaxis - adult |
667 |
663 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
339 |
240 |
$30K |
| D1516 |
|
76 |
73 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,743 |
1,060 |
$24K |
| D2330 |
|
215 |
151 |
$19K |
| D0330 |
Panoramic radiographic image |
277 |
265 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
206 |
152 |
$17K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
12 |
12 |
$16K |
| D2331 |
|
132 |
106 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
355 |
343 |
$9K |
| D9310 |
|
99 |
97 |
$6K |
| D2161 |
|
19 |
16 |
$3K |
| D8660 |
|
73 |
65 |
$2K |
| D2140 |
|
21 |
14 |
$1K |
| D3120 |
|
14 |
13 |
$560.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
12 |
$162.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
44 |
43 |
$0.00 |
| D1999 |
|
1,076 |
875 |
$0.00 |