| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48,116 |
24,181 |
$8.71M |
| D1120 |
Prophylaxis - child |
192,311 |
192,296 |
$7.57M |
| D0120 |
Periodic oral evaluation - established patient |
211,726 |
211,710 |
$7.50M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25,913 |
10,216 |
$6.39M |
| D1208 |
Topical application of fluoride, excluding varnish |
138,746 |
138,738 |
$3.37M |
| D1110 |
Prophylaxis - adult |
47,465 |
47,461 |
$2.54M |
| D1206 |
Topical application of fluoride varnish |
88,369 |
88,363 |
$2.46M |
| D7140 |
Extraction, erupted tooth or exposed root |
20,663 |
12,135 |
$2.27M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17,047 |
10,893 |
$2.20M |
| D0272 |
Bitewings - two radiographic images |
75,487 |
75,477 |
$2.12M |
| D0330 |
Panoramic radiographic image |
22,322 |
22,320 |
$1.51M |
| D1351 |
Sealant - per tooth |
25,321 |
10,900 |
$1.49M |
| D0274 |
Bitewings - four radiographic images |
29,211 |
29,210 |
$1.28M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24,842 |
24,839 |
$1.04M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
766 |
766 |
$720K |
| D2390 |
|
2,409 |
989 |
$628K |
| D0240 |
|
21,085 |
14,783 |
$609K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,948 |
2,077 |
$603K |
| D8670 |
Periodic orthodontic treatment visit |
2,523 |
2,507 |
$582K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,908 |
23,906 |
$556K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,121 |
2,121 |
$528K |
| D0220 |
Intraoral - periapical first radiographic image |
26,964 |
26,942 |
$470K |
| D1510 |
|
1,278 |
1,000 |
$328K |
| D9222 |
|
2,195 |
2,195 |
$281K |
| D0145 |
Oral evaluation for a patient under three years of age |
8,689 |
8,689 |
$259K |
| D2330 |
|
1,600 |
1,042 |
$192K |
| D0210 |
Intraoral - complete series of radiographic images |
10,176 |
10,172 |
$183K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,134 |
8,122 |
$169K |
| D0140 |
Limited oral evaluation - problem focused |
7,842 |
7,828 |
$136K |
| D2931 |
|
393 |
264 |
$119K |
| D2332 |
|
478 |
301 |
$83K |
| D9243 |
|
287 |
287 |
$45K |
| D0340 |
|
1,066 |
1,066 |
$37K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
186 |
183 |
$30K |
| D9248 |
|
1,036 |
1,036 |
$29K |
| D9239 |
|
281 |
281 |
$29K |
| D0270 |
|
1,640 |
1,640 |
$29K |
| D2335 |
|
108 |
58 |
$24K |
| D2331 |
|
67 |
48 |
$10K |
| D7111 |
|
223 |
167 |
$8K |
| D0273 |
|
93 |
93 |
$2K |
| D9612 |
|
376 |
376 |
$2K |
| D9996 |
|
254 |
253 |
$1K |