| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,663 |
12,458 |
$3.53M |
| D1110 |
Prophylaxis - adult |
44,288 |
44,272 |
$3.31M |
| D2740 |
Crown - porcelain/ceramic |
2,657 |
1,801 |
$2.23M |
| D0120 |
Periodic oral evaluation - established patient |
53,670 |
53,658 |
$2.11M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,697 |
5,207 |
$1.99M |
| D1120 |
Prophylaxis - child |
31,743 |
31,738 |
$1.75M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
4,017 |
4,003 |
$1.63M |
| D7240 |
Removal of impacted tooth - completely bony |
3,221 |
2,059 |
$1.50M |
| D7140 |
Extraction, erupted tooth or exposed root |
6,957 |
4,976 |
$1.35M |
| D0274 |
Bitewings - four radiographic images |
26,928 |
26,924 |
$1.28M |
| D0210 |
Intraoral - complete series of radiographic images |
12,178 |
12,125 |
$1.17M |
| D2791 |
|
949 |
776 |
$932K |
| D1208 |
Topical application of fluoride, excluding varnish |
39,365 |
39,363 |
$930K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,477 |
1,948 |
$841K |
| D8670 |
Periodic orthodontic treatment visit |
4,042 |
3,947 |
$827K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,181 |
2,526 |
$802K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,766 |
15,762 |
$792K |
| D2954 |
|
4,231 |
3,408 |
$785K |
| D0140 |
Limited oral evaluation - problem focused |
18,785 |
18,608 |
$719K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,974 |
32,170 |
$693K |
| D9222 |
|
3,802 |
3,800 |
$681K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,687 |
4,257 |
$637K |
| D0220 |
Intraoral - periapical first radiographic image |
45,569 |
45,188 |
$542K |
| D9310 |
|
8,823 |
8,814 |
$526K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
522 |
356 |
$423K |
| D0330 |
Panoramic radiographic image |
4,061 |
4,061 |
$341K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
474 |
450 |
$335K |
| D1351 |
Sealant - per tooth |
5,644 |
2,750 |
$301K |
| D7230 |
|
820 |
733 |
$212K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
712 |
600 |
$198K |
| D3320 |
|
221 |
191 |
$129K |
| D0272 |
Bitewings - two radiographic images |
5,314 |
5,313 |
$126K |
| D0340 |
|
1,449 |
1,449 |
$104K |
| D7250 |
|
275 |
231 |
$88K |
| D2394 |
|
267 |
181 |
$74K |
| D2330 |
|
733 |
360 |
$67K |
| D0470 |
|
1,263 |
1,263 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,004 |
2,759 |
$41K |
| D9944 |
|
198 |
198 |
$40K |
| D8660 |
|
1,075 |
1,074 |
$31K |
| D0270 |
|
1,576 |
1,566 |
$18K |
| D0350 |
|
1,492 |
1,492 |
$16K |
| D1354 |
|
471 |
251 |
$13K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
13 |
13 |
$10K |
| D2335 |
|
16 |
12 |
$4K |
| D4910 |
|
39 |
39 |
$4K |
| D9610 |
|
221 |
221 |
$3K |
| D2332 |
|
18 |
12 |
$3K |
| D2331 |
|
17 |
13 |
$2K |
| D7311 |
|
218 |
203 |
$2K |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$576.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$360.00 |
| D9110 |
|
12 |
12 |
$338.53 |
| D1330 |
|
427 |
427 |
$16.00 |
| D1999 |
|
373 |
349 |
$0.00 |