| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49,965 |
27,864 |
$3.43M |
| D1120 |
Prophylaxis - child |
74,181 |
74,167 |
$3.03M |
| D1206 |
Topical application of fluoride varnish |
85,183 |
85,166 |
$2.15M |
| D0120 |
Periodic oral evaluation - established patient |
84,521 |
84,512 |
$2.07M |
| D1351 |
Sealant - per tooth |
103,707 |
26,235 |
$2.00M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30,742 |
19,095 |
$1.66M |
| D8680 |
|
1,249 |
1,234 |
$1.49M |
| D1110 |
Prophylaxis - adult |
25,141 |
25,140 |
$1.13M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,646 |
1,582 |
$904K |
| D8670 |
Periodic orthodontic treatment visit |
16,763 |
15,989 |
$890K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,072 |
1,054 |
$750K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,173 |
1,040 |
$643K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
7,531 |
5,602 |
$635K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34,300 |
32,556 |
$623K |
| D0330 |
Panoramic radiographic image |
15,287 |
15,178 |
$544K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,820 |
2,769 |
$465K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,770 |
6,174 |
$463K |
| D0603 |
|
41,500 |
41,494 |
$394K |
| D7230 |
|
1,856 |
921 |
$389K |
| D0220 |
Intraoral - periapical first radiographic image |
85,848 |
85,442 |
$371K |
| D0272 |
Bitewings - two radiographic images |
36,880 |
36,852 |
$359K |
| D0210 |
Intraoral - complete series of radiographic images |
7,084 |
7,078 |
$319K |
| D0230 |
Intraoral - periapical each additional radiographic image |
77,763 |
77,611 |
$317K |
| D0274 |
Bitewings - four radiographic images |
25,076 |
25,075 |
$298K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,986 |
11,986 |
$287K |
| D0140 |
Limited oral evaluation - problem focused |
11,226 |
10,954 |
$281K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,896 |
2,396 |
$244K |
| D3320 |
|
522 |
488 |
$235K |
| D9310 |
|
16,941 |
16,790 |
$226K |
| D9248 |
|
928 |
912 |
$183K |
| D2932 |
|
1,223 |
568 |
$182K |
| D1353 |
|
16,910 |
3,787 |
$169K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,775 |
1,190 |
$150K |
| D9920 |
|
7,930 |
7,804 |
$150K |
| D7240 |
Removal of impacted tooth - completely bony |
543 |
279 |
$149K |
| D2954 |
|
1,466 |
1,259 |
$139K |
| D2332 |
|
1,640 |
1,126 |
$114K |
| D2330 |
|
2,287 |
1,433 |
$114K |
| D2335 |
|
1,209 |
862 |
$102K |
| D9420 |
|
319 |
319 |
$101K |
| D7111 |
|
2,159 |
1,440 |
$96K |
| D7250 |
|
945 |
594 |
$94K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,630 |
4,625 |
$94K |
| D4341 |
|
1,232 |
456 |
$80K |
| D2331 |
|
1,201 |
858 |
$78K |
| D0601 |
|
6,868 |
6,868 |
$68K |
| D0340 |
|
4,325 |
4,279 |
$59K |
| D2740 |
Crown - porcelain/ceramic |
102 |
75 |
$56K |
| D3310 |
|
111 |
97 |
$39K |
| D4910 |
|
423 |
423 |
$38K |
| D2950 |
|
596 |
540 |
$33K |
| D2394 |
|
328 |
300 |
$29K |
| D0602 |
|
2,554 |
2,554 |
$26K |
| D0350 |
|
6,261 |
6,149 |
$7K |
| D0270 |
|
1,286 |
1,265 |
$6K |
| D8020 |
|
12 |
12 |
$6K |
| D4355 |
|
42 |
42 |
$5K |
| D1354 |
|
359 |
96 |
$2K |
| D1510 |
|
14 |
13 |
$1K |
| D8692 |
|
12 |
12 |
$890.00 |
| D1555 |
|
12 |
12 |
$275.00 |
| D8660 |
|
2,497 |
2,465 |
$170.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
162 |
162 |
$161.00 |