| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23,400 |
11,903 |
$1.47M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,005 |
8,086 |
$871K |
| D1120 |
Prophylaxis - child |
30,858 |
30,434 |
$869K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,634 |
2,826 |
$819K |
| D8670 |
Periodic orthodontic treatment visit |
2,206 |
2,166 |
$741K |
| D1206 |
Topical application of fluoride varnish |
39,440 |
38,851 |
$671K |
| D0120 |
Periodic oral evaluation - established patient |
37,040 |
36,510 |
$623K |
| D1110 |
Prophylaxis - adult |
11,669 |
11,491 |
$445K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,206 |
3,566 |
$416K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,318 |
13,619 |
$395K |
| D1351 |
Sealant - per tooth |
9,516 |
3,831 |
$254K |
| D0272 |
Bitewings - two radiographic images |
13,127 |
12,912 |
$222K |
| D0330 |
Panoramic radiographic image |
3,241 |
3,187 |
$146K |
| D0274 |
Bitewings - four radiographic images |
6,107 |
5,998 |
$138K |
| D8660 |
|
694 |
688 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,907 |
3,847 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
6,938 |
6,653 |
$62K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
94 |
90 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,942 |
2,490 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
2,408 |
2,338 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,508 |
2,506 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
520 |
416 |
$41K |
| D0240 |
|
3,742 |
2,578 |
$38K |
| D9999 |
Unspecified adjunctive procedure, by report |
343 |
334 |
$37K |
| D2330 |
|
379 |
247 |
$25K |
| D9310 |
|
358 |
346 |
$23K |
| D7960 |
|
55 |
55 |
$19K |
| D1354 |
|
691 |
284 |
$19K |
| D1510 |
|
115 |
86 |
$17K |
| D2332 |
|
179 |
110 |
$16K |
| D2335 |
|
95 |
59 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
673 |
663 |
$11K |
| D2331 |
|
122 |
87 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
47 |
29 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
224 |
142 |
$723.84 |
| D9992 |
|
48 |
43 |
$397.44 |
| D9630 |
|
13 |
13 |
$258.31 |