| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,149 |
3,251 |
$524K |
| D1351 |
Sealant - per tooth |
24,589 |
4,386 |
$478K |
| D1120 |
Prophylaxis - child |
20,510 |
16,949 |
$460K |
| D8670 |
Periodic orthodontic treatment visit |
3,356 |
3,182 |
$332K |
| D1206 |
Topical application of fluoride varnish |
15,746 |
12,702 |
$280K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,544 |
7,634 |
$275K |
| D0120 |
Periodic oral evaluation - established patient |
11,082 |
9,400 |
$238K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,299 |
2,281 |
$237K |
| D0330 |
Panoramic radiographic image |
6,259 |
5,107 |
$221K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,167 |
905 |
$196K |
| D0274 |
Bitewings - four radiographic images |
7,047 |
5,866 |
$139K |
| D0272 |
Bitewings - two radiographic images |
9,958 |
8,113 |
$134K |
| D0220 |
Intraoral - periapical first radiographic image |
10,778 |
8,902 |
$97K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
900 |
558 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,609 |
6,792 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
2,212 |
1,799 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,992 |
3,627 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,081 |
600 |
$54K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
47 |
47 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,429 |
1,152 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
424 |
388 |
$31K |
| D7240 |
Removal of impacted tooth - completely bony |
106 |
13 |
$25K |
| D1110 |
Prophylaxis - adult |
721 |
596 |
$12K |
| D0340 |
|
66 |
57 |
$4K |
| D2330 |
|
49 |
32 |
$4K |
| D9222 |
|
31 |
14 |
$3K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
31 |
14 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
92 |
27 |
$2K |
| D0270 |
|
15 |
14 |
$128.59 |
| D1999 |
|
2,393 |
1,986 |
$0.00 |