| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,702 |
5,598 |
$1.29M |
| D7240 |
Removal of impacted tooth - completely bony |
2,875 |
934 |
$773K |
| D0120 |
Periodic oral evaluation - established patient |
31,244 |
31,043 |
$749K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,116 |
4,281 |
$744K |
| D1110 |
Prophylaxis - adult |
14,827 |
14,640 |
$680K |
| D1120 |
Prophylaxis - child |
19,311 |
19,201 |
$651K |
| D1206 |
Topical application of fluoride varnish |
32,848 |
32,653 |
$630K |
| D1351 |
Sealant - per tooth |
11,865 |
3,790 |
$423K |
| D0240 |
|
16,705 |
16,579 |
$329K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,993 |
9,480 |
$313K |
| D0274 |
Bitewings - four radiographic images |
9,497 |
9,377 |
$287K |
| D0210 |
Intraoral - complete series of radiographic images |
3,501 |
3,478 |
$281K |
| D0272 |
Bitewings - two radiographic images |
11,301 |
11,239 |
$239K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,152 |
1,370 |
$215K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,368 |
592 |
$175K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,355 |
4,308 |
$171K |
| D0140 |
Limited oral evaluation - problem focused |
3,020 |
2,974 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
5,063 |
5,006 |
$74K |
| D2740 |
Crown - porcelain/ceramic |
144 |
120 |
$64K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
367 |
206 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
270 |
225 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,221 |
2,216 |
$32K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
38 |
38 |
$16K |
| D0330 |
Panoramic radiographic image |
268 |
268 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
412 |
412 |
$13K |
| D1354 |
|
648 |
240 |
$7K |
| D2950 |
|
56 |
50 |
$6K |
| D9222 |
|
38 |
38 |
$4K |
| D4342 |
|
39 |
18 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
37 |
26 |
$3K |
| D2330 |
|
16 |
12 |
$2K |
| D9219 |
|
26 |
24 |
$1K |
| D4346 |
|
12 |
12 |
$570.40 |