| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
112,133 |
27,784 |
$2.46M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39,761 |
22,444 |
$2.44M |
| D1120 |
Prophylaxis - child |
64,518 |
63,804 |
$2.37M |
| D0120 |
Periodic oral evaluation - established patient |
86,787 |
85,916 |
$2.05M |
| D1206 |
Topical application of fluoride varnish |
74,750 |
73,808 |
$1.67M |
| D1110 |
Prophylaxis - adult |
33,027 |
32,702 |
$1.48M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20,692 |
12,608 |
$1.08M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,585 |
3,024 |
$634K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
794 |
792 |
$551K |
| D7240 |
Removal of impacted tooth - completely bony |
1,899 |
720 |
$542K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
831 |
767 |
$458K |
| D8680 |
|
384 |
374 |
$456K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27,662 |
26,635 |
$430K |
| D0210 |
Intraoral - complete series of radiographic images |
7,793 |
7,722 |
$382K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,440 |
4,010 |
$357K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,689 |
1,469 |
$354K |
| D7230 |
|
1,556 |
778 |
$351K |
| D8670 |
Periodic orthodontic treatment visit |
7,727 |
7,515 |
$344K |
| D0274 |
Bitewings - four radiographic images |
35,517 |
35,165 |
$342K |
| D0220 |
Intraoral - periapical first radiographic image |
65,286 |
63,649 |
$285K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,001 |
10,861 |
$279K |
| D0330 |
Panoramic radiographic image |
7,600 |
7,499 |
$251K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
485 |
400 |
$241K |
| D0230 |
Intraoral - periapical each additional radiographic image |
76,277 |
52,513 |
$237K |
| D2740 |
Crown - porcelain/ceramic |
384 |
293 |
$212K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,321 |
2,685 |
$204K |
| D0272 |
Bitewings - two radiographic images |
30,992 |
30,655 |
$179K |
| D0603 |
|
28,177 |
27,827 |
$167K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,027 |
1,733 |
$157K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,943 |
6,858 |
$157K |
| D9222 |
|
2,076 |
1,727 |
$143K |
| D9310 |
|
8,920 |
8,781 |
$133K |
| D0140 |
Limited oral evaluation - problem focused |
6,364 |
6,272 |
$106K |
| D0601 |
|
13,972 |
13,816 |
$80K |
| D2932 |
|
662 |
269 |
$77K |
| D7111 |
|
1,873 |
1,232 |
$68K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,120 |
617 |
$54K |
| D2950 |
|
1,088 |
818 |
$48K |
| D0340 |
|
2,806 |
2,799 |
$39K |
| D2332 |
|
742 |
502 |
$37K |
| D8060 |
|
73 |
73 |
$36K |
| D7250 |
|
443 |
216 |
$36K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,711 |
1,702 |
$26K |
| D0602 |
|
3,844 |
3,804 |
$23K |
| D3320 |
|
29 |
24 |
$16K |
| D2330 |
|
380 |
228 |
$14K |
| D9920 |
|
614 |
601 |
$8K |
| D2954 |
|
89 |
68 |
$7K |
| D8220 |
|
30 |
30 |
$6K |
| D0350 |
|
3,919 |
3,893 |
$4K |
| D8704 |
|
44 |
44 |
$3K |
| D8660 |
|
486 |
474 |
$3K |
| D8703 |
|
34 |
34 |
$3K |
| D2394 |
|
31 |
28 |
$2K |
| D4341 |
|
34 |
14 |
$2K |
| D8692 |
|
26 |
25 |
$2K |
| D2331 |
|
18 |
13 |
$975.00 |
| D0270 |
|
138 |
135 |
$625.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
112 |
104 |
$25.00 |
| D1353 |
|
85 |
13 |
$20.00 |