| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19,374 |
9,608 |
$1.44M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22,994 |
8,830 |
$1.40M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,935 |
2,228 |
$710K |
| D8670 |
Periodic orthodontic treatment visit |
1,669 |
1,659 |
$599K |
| D9920 |
|
9,984 |
9,497 |
$585K |
| D1120 |
Prophylaxis - child |
17,077 |
16,921 |
$484K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,260 |
26,991 |
$477K |
| D1110 |
Prophylaxis - adult |
11,399 |
11,244 |
$441K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,328 |
3,398 |
$427K |
| D0120 |
Periodic oral evaluation - established patient |
24,852 |
24,600 |
$415K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,050 |
2,756 |
$375K |
| D0274 |
Bitewings - four radiographic images |
12,753 |
12,615 |
$293K |
| D9630 |
|
17,107 |
16,941 |
$280K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,923 |
1,671 |
$278K |
| D9248 |
|
2,921 |
2,601 |
$269K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,162 |
6,470 |
$206K |
| D1351 |
Sealant - per tooth |
5,036 |
2,322 |
$140K |
| D0210 |
Intraoral - complete series of radiographic images |
3,749 |
3,394 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,744 |
3,652 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
4,473 |
4,246 |
$79K |
| D2330 |
|
1,077 |
642 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
5,883 |
5,701 |
$51K |
| D0240 |
|
4,133 |
2,240 |
$46K |
| D8660 |
|
278 |
278 |
$38K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
38 |
38 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,409 |
2,398 |
$37K |
| D2332 |
|
312 |
168 |
$35K |
| D0330 |
Panoramic radiographic image |
684 |
653 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,009 |
1,003 |
$19K |
| D3120 |
|
807 |
518 |
$15K |
| D1515 |
|
60 |
50 |
$13K |
| D2390 |
|
178 |
83 |
$11K |
| D9310 |
|
39 |
37 |
$4K |
| D2950 |
|
223 |
144 |
$4K |
| D1516 |
|
14 |
14 |
$3K |
| D1517 |
|
12 |
12 |
$3K |
| D2331 |
|
20 |
15 |
$2K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
18 |
12 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
185 |
117 |
$0.00 |
| D4341 |
|
133 |
46 |
$0.00 |
| D1999 |
|
20 |
20 |
$0.00 |