| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,704 |
10,991 |
$1.81M |
| D8670 |
Periodic orthodontic treatment visit |
7,142 |
7,081 |
$1.80M |
| D1120 |
Prophylaxis - child |
34,184 |
33,956 |
$1.76M |
| D0120 |
Periodic oral evaluation - established patient |
45,482 |
45,146 |
$1.32M |
| D1206 |
Topical application of fluoride varnish |
47,374 |
46,997 |
$1.24M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13,129 |
9,024 |
$1.13M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,563 |
3,153 |
$1.12M |
| D1110 |
Prophylaxis - adult |
16,373 |
16,246 |
$1.11M |
| D1351 |
Sealant - per tooth |
26,017 |
10,011 |
$1.07M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
842 |
833 |
$996K |
| D0274 |
Bitewings - four radiographic images |
21,404 |
21,232 |
$904K |
| D7240 |
Removal of impacted tooth - completely bony |
2,460 |
815 |
$891K |
| D0272 |
Bitewings - two radiographic images |
18,469 |
18,349 |
$554K |
| D0330 |
Panoramic radiographic image |
10,102 |
10,006 |
$413K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,371 |
2,730 |
$393K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,614 |
6,503 |
$321K |
| D0220 |
Intraoral - periapical first radiographic image |
15,847 |
15,587 |
$300K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,770 |
1,231 |
$266K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,748 |
1,828 |
$263K |
| D0140 |
Limited oral evaluation - problem focused |
5,377 |
5,275 |
$230K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,348 |
9,402 |
$158K |
| D8690 |
|
1,051 |
1,042 |
$130K |
| D8660 |
|
723 |
714 |
$92K |
| D8680 |
|
918 |
839 |
$85K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,614 |
3,475 |
$75K |
| D7111 |
|
785 |
556 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
602 |
584 |
$39K |
| D2332 |
|
277 |
198 |
$37K |
| D2140 |
|
387 |
320 |
$30K |
| D0180 |
|
622 |
619 |
$29K |
| D0270 |
|
2,145 |
2,113 |
$29K |
| D2330 |
|
323 |
198 |
$28K |
| D7230 |
|
98 |
56 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
267 |
160 |
$25K |
| D3120 |
|
415 |
367 |
$16K |
| D8999 |
|
188 |
164 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
44 |
26 |
$5K |
| D2335 |
|
24 |
13 |
$4K |
| D9310 |
|
29 |
12 |
$0.00 |
| D1999 |
|
7,874 |
6,698 |
$0.00 |
| D0350 |
|
121 |
121 |
$0.00 |