| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
5,618 |
4,057 |
$2.83M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,051 |
1,706 |
$917K |
| D1351 |
Sealant - per tooth |
34,613 |
5,181 |
$707K |
| D0140 |
Limited oral evaluation - problem focused |
15,031 |
14,553 |
$570K |
| D1120 |
Prophylaxis - child |
13,899 |
13,696 |
$563K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,080 |
2,946 |
$507K |
| D1110 |
Prophylaxis - adult |
12,032 |
11,916 |
$498K |
| D2954 |
|
4,610 |
3,535 |
$415K |
| D0120 |
Periodic oral evaluation - established patient |
18,195 |
18,004 |
$408K |
| D1206 |
Topical application of fluoride varnish |
13,120 |
12,901 |
$379K |
| D3320 |
|
866 |
729 |
$304K |
| D0210 |
Intraoral - complete series of radiographic images |
5,453 |
5,447 |
$268K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,257 |
11,170 |
$240K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,371 |
2,252 |
$162K |
| D0330 |
Panoramic radiographic image |
8,053 |
7,890 |
$158K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,598 |
1,401 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,045 |
5,970 |
$137K |
| D4341 |
|
1,872 |
698 |
$113K |
| D0274 |
Bitewings - four radiographic images |
10,972 |
10,810 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,342 |
1,654 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
13,184 |
12,789 |
$56K |
| D4910 |
|
486 |
475 |
$45K |
| D2750 |
|
75 |
53 |
$42K |
| D7240 |
Removal of impacted tooth - completely bony |
154 |
56 |
$39K |
| D0272 |
Bitewings - two radiographic images |
4,083 |
4,019 |
$33K |
| D0602 |
|
3,293 |
3,219 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
380 |
279 |
$23K |
| D0603 |
|
2,428 |
2,391 |
$21K |
| D3310 |
|
60 |
48 |
$16K |
| D0601 |
|
1,527 |
1,524 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
642 |
563 |
$14K |
| D2331 |
|
144 |
99 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,942 |
3,257 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
64 |
51 |
$7K |
| D2332 |
|
67 |
39 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
47 |
39 |
$3K |
| D2330 |
|
61 |
37 |
$3K |
| D9310 |
|
108 |
103 |
$1K |
| D2950 |
|
19 |
14 |
$924.00 |
| D1353 |
|
80 |
17 |
$800.00 |
| D9920 |
|
41 |
37 |
$733.00 |