| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
81,791 |
39,842 |
$4.73M |
| D0120 |
Periodic oral evaluation - established patient |
141,160 |
140,292 |
$3.19M |
| D1120 |
Prophylaxis - child |
94,752 |
94,323 |
$2.35M |
| D8670 |
Periodic orthodontic treatment visit |
45,315 |
41,215 |
$2.34M |
| D1110 |
Prophylaxis - adult |
67,336 |
66,675 |
$2.22M |
| D7240 |
Removal of impacted tooth - completely bony |
6,350 |
2,522 |
$2.06M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47,456 |
25,324 |
$2.04M |
| D0210 |
Intraoral - complete series of radiographic images |
43,944 |
43,818 |
$1.91M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20,298 |
10,071 |
$1.69M |
| D8680 |
|
1,218 |
1,191 |
$1.47M |
| D1351 |
Sealant - per tooth |
83,334 |
18,084 |
$1.42M |
| D2751 |
Crown - porcelain fused to predominantly base metal |
3,017 |
2,218 |
$1.26M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,948 |
1,756 |
$1.21M |
| D7230 |
|
4,591 |
2,645 |
$1.10M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,349 |
1,343 |
$1.01M |
| D0274 |
Bitewings - four radiographic images |
58,705 |
58,035 |
$912K |
| D1208 |
Topical application of fluoride, excluding varnish |
72,874 |
72,383 |
$888K |
| D0140 |
Limited oral evaluation - problem focused |
41,998 |
40,785 |
$881K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
11,977 |
8,190 |
$774K |
| D0220 |
Intraoral - periapical first radiographic image |
121,605 |
117,875 |
$679K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,313 |
4,780 |
$654K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32,383 |
32,076 |
$649K |
| D0230 |
Intraoral - periapical each additional radiographic image |
125,814 |
90,436 |
$468K |
| D2740 |
Crown - porcelain/ceramic |
1,139 |
856 |
$461K |
| D7250 |
|
2,751 |
1,514 |
$447K |
| D1206 |
Topical application of fluoride varnish |
34,181 |
33,934 |
$404K |
| D0330 |
Panoramic radiographic image |
27,863 |
27,446 |
$394K |
| D7111 |
|
7,348 |
4,432 |
$383K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,383 |
4,984 |
$378K |
| D0272 |
Bitewings - two radiographic images |
29,896 |
29,493 |
$307K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,110 |
4,381 |
$300K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
5,397 |
2,848 |
$283K |
| D4341 |
|
4,935 |
1,973 |
$257K |
| D8660 |
|
5,757 |
5,671 |
$240K |
| D2950 |
|
3,795 |
3,096 |
$231K |
| D3320 |
|
372 |
335 |
$215K |
| D9310 |
|
9,791 |
9,647 |
$198K |
| D2954 |
|
2,050 |
1,569 |
$179K |
| D9222 |
|
2,827 |
2,761 |
$144K |
| D2332 |
|
2,138 |
1,351 |
$138K |
| D2330 |
|
2,782 |
1,931 |
$116K |
| D3310 |
|
214 |
163 |
$113K |
| D2335 |
|
1,299 |
852 |
$103K |
| D0603 |
|
10,790 |
10,719 |
$92K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,916 |
6,364 |
$89K |
| D4910 |
|
1,733 |
1,715 |
$85K |
| D2331 |
|
1,297 |
889 |
$78K |
| D2933 |
|
468 |
197 |
$76K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,168 |
3,151 |
$63K |
| D1510 |
|
621 |
539 |
$63K |
| D0240 |
|
8,434 |
6,362 |
$59K |
| D7220 |
|
263 |
221 |
$40K |
| D5110 |
|
81 |
81 |
$36K |
| D2394 |
|
427 |
356 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
488 |
300 |
$27K |
| D5225 |
|
58 |
58 |
$26K |
| D1353 |
|
2,049 |
560 |
$20K |
| D0270 |
|
2,825 |
2,643 |
$17K |
| D7310 |
|
178 |
92 |
$15K |
| D0602 |
|
1,581 |
1,571 |
$13K |
| D0601 |
|
1,563 |
1,542 |
$11K |
| D4342 |
|
213 |
119 |
$8K |
| D7311 |
|
181 |
116 |
$8K |
| D7280 |
|
21 |
12 |
$4K |
| D0277 |
|
135 |
134 |
$3K |
| D2920 |
|
334 |
308 |
$3K |
| D9610 |
|
1,151 |
1,136 |
$3K |
| D3331 |
|
61 |
51 |
$3K |
| D2390 |
|
21 |
14 |
$2K |
| D1354 |
|
669 |
222 |
$2K |
| D7286 |
|
12 |
12 |
$2K |
| D4355 |
|
27 |
25 |
$1K |
| D2931 |
|
12 |
12 |
$1K |
| D2160 |
|
14 |
12 |
$857.08 |
| D2140 |
|
17 |
12 |
$733.04 |
| D9920 |
|
67 |
64 |
$731.00 |
| D0251 |
|
31 |
31 |
$692.92 |
| D8704 |
|
15 |
15 |
$675.00 |
| D8703 |
|
16 |
16 |
$665.00 |
| D2940 |
|
48 |
44 |
$352.80 |
| D1330 |
|
20,301 |
20,037 |
$0.00 |
| D1999 |
|
237 |
229 |
$0.00 |