| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18,687 |
10,272 |
$1.41M |
| D1120 |
Prophylaxis - child |
32,680 |
32,423 |
$933K |
| D8670 |
Periodic orthodontic treatment visit |
2,554 |
2,549 |
$849K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,069 |
1,690 |
$721K |
| D9630 |
|
41,497 |
41,143 |
$684K |
| D1206 |
Topical application of fluoride varnish |
39,824 |
39,463 |
$680K |
| D0120 |
Periodic oral evaluation - established patient |
39,363 |
39,055 |
$660K |
| D1110 |
Prophylaxis - adult |
16,274 |
16,146 |
$629K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,705 |
16,297 |
$512K |
| D1351 |
Sealant - per tooth |
15,573 |
6,266 |
$436K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,511 |
4,025 |
$415K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,520 |
4,558 |
$414K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,979 |
2,900 |
$383K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,977 |
1,190 |
$363K |
| D0272 |
Bitewings - two radiographic images |
13,420 |
13,302 |
$231K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,537 |
7,329 |
$205K |
| D0274 |
Bitewings - four radiographic images |
8,991 |
8,925 |
$205K |
| D9310 |
|
2,733 |
2,704 |
$185K |
| D0210 |
Intraoral - complete series of radiographic images |
4,138 |
3,779 |
$159K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,748 |
7,745 |
$157K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
159 |
155 |
$135K |
| D8660 |
|
915 |
911 |
$107K |
| D0330 |
Panoramic radiographic image |
1,804 |
1,691 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
3,489 |
3,270 |
$70K |
| D9248 |
|
678 |
658 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
5,614 |
5,309 |
$53K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,928 |
1,920 |
$33K |
| D9920 |
|
467 |
467 |
$31K |
| D2934 |
|
75 |
28 |
$18K |
| D9420 |
|
247 |
247 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
67 |
40 |
$10K |
| D0340 |
|
79 |
79 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
37 |
37 |
$6K |
| D8692 |
|
41 |
29 |
$5K |
| D8703 |
|
29 |
29 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
339 |
173 |
$4K |
| D8704 |
|
28 |
28 |
$4K |
| D3120 |
|
220 |
166 |
$2K |
| D2950 |
|
17 |
16 |
$2K |
| D7240 |
Removal of impacted tooth - completely bony |
37 |
12 |
$0.00 |