| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,302 |
8,624 |
$3.93M |
| D1120 |
Prophylaxis - child |
31,484 |
29,689 |
$1.63M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,847 |
4,853 |
$1.51M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,754 |
2,921 |
$1.42M |
| D1351 |
Sealant - per tooth |
30,582 |
6,633 |
$1.30M |
| D0230 |
Intraoral - periapical each additional radiographic image |
63,619 |
34,941 |
$1.27M |
| D1206 |
Topical application of fluoride varnish |
40,919 |
38,652 |
$1.25M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,155 |
14,213 |
$1.01M |
| D0220 |
Intraoral - periapical first radiographic image |
39,525 |
36,762 |
$918K |
| D0120 |
Periodic oral evaluation - established patient |
23,078 |
21,835 |
$910K |
| D0274 |
Bitewings - four radiographic images |
14,560 |
13,959 |
$721K |
| D0330 |
Panoramic radiographic image |
8,630 |
8,232 |
$709K |
| D1110 |
Prophylaxis - adult |
10,317 |
9,879 |
$691K |
| D8670 |
Periodic orthodontic treatment visit |
4,557 |
4,272 |
$678K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,362 |
1,915 |
$668K |
| D0272 |
Bitewings - two radiographic images |
18,470 |
17,417 |
$642K |
| D8660 |
|
1,372 |
1,297 |
$443K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,269 |
1,837 |
$437K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,109 |
4,592 |
$380K |
| D9944 |
|
450 |
435 |
$220K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,624 |
3,348 |
$185K |
| D2330 |
|
1,004 |
671 |
$181K |
| D7111 |
|
1,405 |
902 |
$160K |
| D0140 |
Limited oral evaluation - problem focused |
2,241 |
2,096 |
$132K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
95 |
64 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
501 |
328 |
$84K |
| D2950 |
|
207 |
143 |
$58K |
| D2394 |
|
166 |
122 |
$57K |
| D2332 |
|
148 |
105 |
$40K |
| D8020 |
|
16 |
12 |
$34K |
| D2335 |
|
47 |
25 |
$14K |
| D2390 |
|
25 |
13 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
12 |
$13K |
| D2331 |
|
26 |
19 |
$5K |
| D9920 |
|
13 |
12 |
$2K |
| D0270 |
|
43 |
42 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
12 |
$373.32 |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
19 |
$112.24 |
| D1999 |
|
471 |
378 |
$0.00 |
| D0602 |
|
23,295 |
21,847 |
$0.00 |
| D0603 |
|
17,488 |
16,519 |
$0.00 |
| D0601 |
|
342 |
312 |
$0.00 |