| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
85,425 |
82,094 |
$3.80M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
51,094 |
14,482 |
$3.64M |
| D1120 |
Prophylaxis - child |
68,106 |
65,343 |
$3.29M |
| D1351 |
Sealant - per tooth |
140,629 |
27,638 |
$2.82M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
32,666 |
7,117 |
$2.54M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56,870 |
54,314 |
$1.78M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30,871 |
15,679 |
$1.56M |
| D0140 |
Limited oral evaluation - problem focused |
44,440 |
42,455 |
$1.39M |
| D0120 |
Periodic oral evaluation - established patient |
44,740 |
43,128 |
$1.29M |
| D7140 |
Extraction, erupted tooth or exposed root |
32,528 |
12,481 |
$1.29M |
| D0274 |
Bitewings - four radiographic images |
59,454 |
57,045 |
$1.26M |
| D0220 |
Intraoral - periapical first radiographic image |
87,966 |
84,197 |
$1.23M |
| D0230 |
Intraoral - periapical each additional radiographic image |
200,888 |
97,564 |
$1.16M |
| D0210 |
Intraoral - complete series of radiographic images |
23,113 |
21,917 |
$1.15M |
| D9310 |
|
19,203 |
18,012 |
$1.06M |
| D2929 |
|
8,592 |
2,409 |
$1.02M |
| D0330 |
Panoramic radiographic image |
26,372 |
25,283 |
$847K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
15,816 |
9,166 |
$765K |
| D7240 |
Removal of impacted tooth - completely bony |
5,582 |
2,598 |
$747K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
12,245 |
3,883 |
$634K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13,460 |
8,154 |
$528K |
| D1110 |
Prophylaxis - adult |
12,782 |
12,405 |
$504K |
| D3230 |
|
5,730 |
1,740 |
$501K |
| D9222 |
|
9,952 |
9,464 |
$491K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
23,222 |
21,254 |
$403K |
| D7220 |
|
3,551 |
1,725 |
$385K |
| D0272 |
Bitewings - two radiographic images |
19,840 |
19,220 |
$335K |
| D7230 |
|
2,534 |
1,477 |
$294K |
| D1353 |
|
16,859 |
4,742 |
$252K |
| D9420 |
|
5,386 |
5,207 |
$211K |
| D1510 |
|
2,045 |
1,272 |
$165K |
| D2740 |
Crown - porcelain/ceramic |
412 |
244 |
$143K |
| D2933 |
|
1,296 |
362 |
$128K |
| D0999 |
Unspecified diagnostic procedure, by report |
3,849 |
3,849 |
$116K |
| D7310 |
|
1,511 |
528 |
$110K |
| D9999 |
Unspecified adjunctive procedure, by report |
5,278 |
5,278 |
$105K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,441 |
954 |
$85K |
| D0270 |
|
6,050 |
5,782 |
$62K |
| D2950 |
|
572 |
346 |
$47K |
| D4346 |
|
555 |
541 |
$34K |
| D5110 |
|
71 |
62 |
$30K |
| D2330 |
|
430 |
243 |
$23K |
| D1999 |
|
30,900 |
27,967 |
$16K |
| D5214 |
|
25 |
25 |
$15K |
| D5899 |
|
949 |
675 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
747 |
721 |
$14K |
| D7311 |
|
183 |
98 |
$13K |
| D1354 |
|
1,120 |
344 |
$13K |
| D0160 |
|
500 |
468 |
$12K |
| D5130 |
|
12 |
12 |
$8K |
| D7241 |
|
45 |
26 |
$8K |
| D9951 |
|
1,063 |
426 |
$4K |
| D0350 |
|
13,550 |
12,852 |
$4K |
| D0603 |
|
4,411 |
3,362 |
$3K |
| D0602 |
|
4,062 |
3,185 |
$3K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
19 |
15 |
$3K |
| D0601 |
|
2,778 |
2,153 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
218 |
208 |
$2K |
| D1517 |
|
13 |
12 |
$1K |
| D4341 |
|
130 |
39 |
$1K |
| D7111 |
|
38 |
19 |
$1K |
| D9995 |
|
68 |
63 |
$430.50 |
| D3120 |
|
23 |
16 |
$415.80 |
| D9612 |
|
40 |
37 |
$327.92 |
| D0273 |
|
42 |
42 |
$196.80 |