| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,711 |
2,266 |
$187K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
562 |
444 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
6,957 |
6,935 |
$127K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,474 |
1,232 |
$111K |
| D8670 |
Periodic orthodontic treatment visit |
1,748 |
1,710 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,567 |
1,415 |
$86K |
| D1120 |
Prophylaxis - child |
5,043 |
5,027 |
$83K |
| D1110 |
Prophylaxis - adult |
3,992 |
3,977 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,097 |
2,090 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,270 |
5,269 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
1,464 |
1,462 |
$40K |
| D0274 |
Bitewings - four radiographic images |
3,715 |
3,699 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,885 |
1,818 |
$33K |
| D2954 |
|
670 |
555 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
8,626 |
8,314 |
$33K |
| D9920 |
|
1,538 |
1,472 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,344 |
7,088 |
$21K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
74 |
72 |
$18K |
| D1351 |
Sealant - per tooth |
1,359 |
177 |
$14K |
| D2394 |
|
238 |
155 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
360 |
240 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,572 |
1,565 |
$8K |
| D9310 |
|
328 |
320 |
$5K |
| D1206 |
Topical application of fluoride varnish |
250 |
230 |
$4K |
| D0330 |
Panoramic radiographic image |
215 |
215 |
$3K |
| D3320 |
|
14 |
13 |
$3K |
| D8660 |
|
44 |
44 |
$2K |
| D0340 |
|
113 |
113 |
$2K |
| D2330 |
|
41 |
24 |
$1K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
12 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
26 |
$1K |
| D4355 |
|
24 |
24 |
$1K |
| D0603 |
|
139 |
128 |
$940.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
92 |
82 |
$893.00 |
| D0270 |
|
260 |
254 |
$780.00 |
| D2331 |
|
18 |
14 |
$765.00 |
| D2332 |
|
15 |
12 |
$742.50 |
| D0602 |
|
17 |
15 |
$120.00 |
| D0350 |
|
114 |
114 |
$114.00 |
| D1999 |
|
1,157 |
1,045 |
$0.00 |