| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38,002 |
20,290 |
$2.83M |
| D1120 |
Prophylaxis - child |
64,503 |
64,163 |
$2.40M |
| D0120 |
Periodic oral evaluation - established patient |
61,072 |
60,759 |
$1.87M |
| D1206 |
Topical application of fluoride varnish |
67,354 |
67,026 |
$1.50M |
| D1351 |
Sealant - per tooth |
59,583 |
16,583 |
$1.32M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16,946 |
10,929 |
$982K |
| D8670 |
Periodic orthodontic treatment visit |
17,253 |
16,846 |
$967K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,369 |
2,515 |
$515K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,004 |
4,634 |
$502K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22,916 |
21,718 |
$441K |
| D0272 |
Bitewings - two radiographic images |
33,055 |
32,919 |
$440K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,816 |
5,133 |
$390K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,586 |
8,521 |
$269K |
| D0220 |
Intraoral - periapical first radiographic image |
51,744 |
51,238 |
$265K |
| D8660 |
|
5,639 |
5,607 |
$242K |
| D0274 |
Bitewings - four radiographic images |
12,187 |
12,104 |
$239K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
317 |
317 |
$225K |
| D0603 |
|
24,262 |
24,145 |
$224K |
| D8680 |
|
201 |
199 |
$192K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,276 |
1,717 |
$185K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,207 |
45,749 |
$183K |
| D1110 |
Prophylaxis - adult |
6,877 |
6,835 |
$176K |
| D9920 |
|
8,106 |
7,082 |
$148K |
| D0140 |
Limited oral evaluation - problem focused |
3,678 |
3,636 |
$96K |
| D2332 |
|
961 |
665 |
$66K |
| D0602 |
|
6,499 |
6,466 |
$63K |
| D2330 |
|
1,191 |
812 |
$62K |
| D0601 |
|
5,958 |
5,938 |
$58K |
| D9420 |
|
169 |
166 |
$52K |
| D2932 |
|
321 |
135 |
$40K |
| D1353 |
|
3,321 |
1,131 |
$33K |
| D0330 |
Panoramic radiographic image |
1,029 |
1,029 |
$33K |
| D1515 |
|
135 |
106 |
$23K |
| D0270 |
|
4,182 |
4,158 |
$21K |
| D0273 |
|
1,585 |
1,568 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
468 |
465 |
$17K |
| D2331 |
|
271 |
186 |
$16K |
| D9999 |
Unspecified adjunctive procedure, by report |
131 |
130 |
$12K |
| D2335 |
|
116 |
65 |
$10K |
| D7111 |
|
197 |
154 |
$10K |
| D8020 |
|
15 |
15 |
$7K |
| D1354 |
|
1,102 |
288 |
$6K |
| D0340 |
|
227 |
227 |
$4K |
| D9430 |
|
241 |
236 |
$3K |
| D9310 |
|
130 |
126 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
150 |
146 |
$2K |
| D9110 |
|
172 |
169 |
$2K |
| D0191 |
|
84 |
79 |
$1K |
| D2394 |
|
16 |
12 |
$895.00 |
| D9995 |
|
51 |
50 |
$880.00 |
| D0251 |
|
13 |
13 |
$258.00 |
| D0350 |
|
58 |
58 |
$58.00 |