| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,370 |
5,853 |
$1.35M |
| D8670 |
Periodic orthodontic treatment visit |
13,312 |
12,605 |
$1.15M |
| D1110 |
Prophylaxis - adult |
11,197 |
10,857 |
$568K |
| D0120 |
Periodic oral evaluation - established patient |
21,110 |
20,481 |
$541K |
| D0274 |
Bitewings - four radiographic images |
12,625 |
12,269 |
$441K |
| D1120 |
Prophylaxis - child |
11,087 |
10,751 |
$409K |
| D1206 |
Topical application of fluoride varnish |
19,015 |
18,466 |
$394K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,159 |
2,036 |
$343K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,774 |
3,107 |
$338K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,087 |
835 |
$281K |
| D8090 |
|
89 |
83 |
$252K |
| D0330 |
Panoramic radiographic image |
4,135 |
3,968 |
$199K |
| D0140 |
Limited oral evaluation - problem focused |
5,740 |
5,587 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,469 |
5,264 |
$191K |
| D0210 |
Intraoral - complete series of radiographic images |
2,955 |
2,831 |
$189K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
970 |
673 |
$166K |
| D1351 |
Sealant - per tooth |
5,759 |
2,030 |
$166K |
| D0220 |
Intraoral - periapical first radiographic image |
8,388 |
8,085 |
$142K |
| D9310 |
|
2,596 |
2,494 |
$133K |
| D2740 |
Crown - porcelain/ceramic |
185 |
173 |
$108K |
| D8680 |
|
466 |
384 |
$104K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
204 |
185 |
$97K |
| D0350 |
|
2,545 |
2,444 |
$81K |
| D0272 |
Bitewings - two radiographic images |
2,883 |
2,798 |
$64K |
| D2950 |
|
512 |
460 |
$63K |
| D0340 |
|
1,867 |
1,565 |
$54K |
| D1310 |
|
926 |
914 |
$38K |
| D1330 |
|
1,195 |
1,176 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,811 |
1,740 |
$31K |
| D0240 |
|
1,078 |
876 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
566 |
553 |
$19K |
| D0425 |
|
1,321 |
1,299 |
$18K |
| D4910 |
|
227 |
216 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
94 |
68 |
$11K |
| D9248 |
|
72 |
67 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
843 |
735 |
$10K |
| D9243 |
|
39 |
36 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
40 |
28 |
$5K |
| D9239 |
|
39 |
36 |
$3K |
| D1352 |
|
81 |
55 |
$3K |
| D0603 |
|
689 |
683 |
$2K |
| D9630 |
|
90 |
90 |
$1K |
| D2330 |
|
18 |
12 |
$1K |
| D0602 |
|
12 |
12 |
$10.13 |