| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21,723 |
11,688 |
$1.64M |
| D1120 |
Prophylaxis - child |
52,891 |
52,241 |
$1.47M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,399 |
4,903 |
$1.22M |
| D1206 |
Topical application of fluoride varnish |
65,996 |
65,179 |
$1.14M |
| D0120 |
Periodic oral evaluation - established patient |
58,175 |
57,456 |
$966K |
| D8670 |
Periodic orthodontic treatment visit |
2,266 |
2,227 |
$746K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,201 |
7,250 |
$736K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21,987 |
20,354 |
$620K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,766 |
5,972 |
$587K |
| D1110 |
Prophylaxis - adult |
12,790 |
12,615 |
$475K |
| D1351 |
Sealant - per tooth |
15,725 |
5,173 |
$472K |
| D0272 |
Bitewings - two radiographic images |
19,155 |
18,906 |
$314K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,312 |
8,205 |
$230K |
| D0210 |
Intraoral - complete series of radiographic images |
4,167 |
3,919 |
$218K |
| D9920 |
|
3,007 |
2,896 |
$178K |
| D0274 |
Bitewings - four radiographic images |
7,406 |
7,298 |
$160K |
| D8660 |
|
882 |
861 |
$126K |
| D0140 |
Limited oral evaluation - problem focused |
5,222 |
5,098 |
$109K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
938 |
763 |
$103K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
116 |
116 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
11,117 |
10,926 |
$94K |
| D9310 |
|
1,068 |
1,062 |
$85K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
962 |
576 |
$76K |
| D9248 |
|
659 |
637 |
$72K |
| D2390 |
|
314 |
139 |
$50K |
| D9994 |
|
5,597 |
5,484 |
$46K |
| D2929 |
|
328 |
84 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,145 |
4,047 |
$43K |
| D2330 |
|
559 |
373 |
$41K |
| D9999 |
Unspecified adjunctive procedure, by report |
402 |
402 |
$39K |
| D0330 |
Panoramic radiographic image |
574 |
564 |
$29K |
| D0240 |
|
1,228 |
925 |
$15K |
| D2332 |
|
99 |
68 |
$11K |
| D1354 |
|
982 |
248 |
$11K |
| D8680 |
|
13 |
13 |
$6K |
| D9110 |
|
110 |
109 |
$5K |
| D3120 |
|
256 |
191 |
$3K |
| D2331 |
|
29 |
25 |
$3K |
| D9630 |
|
25 |
24 |
$457.79 |
| D0145 |
Oral evaluation for a patient under three years of age |
378 |
378 |
$382.85 |
| D9420 |
|
15 |
15 |
$0.00 |
| D8999 |
|
12 |
12 |
$0.00 |