| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112,100 |
62,669 |
$8.15M |
| D1120 |
Prophylaxis - child |
217,739 |
216,782 |
$6.94M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
160,435 |
159,650 |
$5.60M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
96,238 |
50,347 |
$5.27M |
| D1208 |
Topical application of fluoride, excluding varnish |
264,752 |
263,543 |
$4.82M |
| D0274 |
Bitewings - four radiographic images |
127,087 |
126,577 |
$3.75M |
| D0220 |
Intraoral - periapical first radiographic image |
246,802 |
244,561 |
$2.81M |
| D0120 |
Periodic oral evaluation - established patient |
109,666 |
109,242 |
$2.49M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
80,751 |
72,847 |
$2.20M |
| D0230 |
Intraoral - periapical each additional radiographic image |
234,558 |
229,614 |
$2.17M |
| D7140 |
Extraction, erupted tooth or exposed root |
31,403 |
17,979 |
$2.07M |
| D1110 |
Prophylaxis - adult |
42,879 |
42,689 |
$1.95M |
| D0272 |
Bitewings - two radiographic images |
86,065 |
85,704 |
$1.76M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19,557 |
14,229 |
$1.69M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,913 |
7,349 |
$1.29M |
| D1351 |
Sealant - per tooth |
43,406 |
14,618 |
$1.03M |
| D4346 |
|
6,377 |
6,342 |
$741K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,335 |
2,261 |
$602K |
| D0330 |
Panoramic radiographic image |
10,317 |
10,218 |
$518K |
| D2330 |
|
7,231 |
4,240 |
$503K |
| D0210 |
Intraoral - complete series of radiographic images |
7,595 |
7,420 |
$424K |
| D7510 |
|
3,447 |
1,842 |
$417K |
| D0140 |
Limited oral evaluation - problem focused |
12,394 |
12,151 |
$367K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,238 |
2,838 |
$334K |
| D2332 |
|
2,598 |
1,633 |
$278K |
| D2335 |
|
1,731 |
1,108 |
$220K |
| D9110 |
|
3,329 |
3,291 |
$184K |
| D2331 |
|
2,012 |
1,371 |
$174K |
| D2394 |
|
937 |
696 |
$98K |
| D0240 |
|
5,716 |
3,220 |
$71K |
| D0270 |
|
3,301 |
3,261 |
$33K |
| D7971 |
|
398 |
261 |
$22K |
| D4341 |
|
143 |
45 |
$18K |
| D3310 |
|
44 |
24 |
$13K |
| D2950 |
|
118 |
72 |
$13K |
| D7240 |
Removal of impacted tooth - completely bony |
36 |
12 |
$6K |
| D7220 |
|
43 |
25 |
$6K |
| D2940 |
|
109 |
88 |
$5K |
| D1206 |
Topical application of fluoride varnish |
44 |
44 |
$816.62 |