| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
5,449 |
1,275 |
$648K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,354 |
3,114 |
$644K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,907 |
1,240 |
$284K |
| D1206 |
Topical application of fluoride varnish |
15,461 |
13,390 |
$278K |
| D0120 |
Periodic oral evaluation - established patient |
11,917 |
10,642 |
$274K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,762 |
1,576 |
$223K |
| D1351 |
Sealant - per tooth |
14,305 |
1,327 |
$221K |
| D4346 |
|
3,735 |
2,951 |
$213K |
| D1110 |
Prophylaxis - adult |
4,761 |
4,441 |
$204K |
| D4342 |
|
1,981 |
622 |
$192K |
| D0330 |
Panoramic radiographic image |
3,603 |
3,139 |
$187K |
| D1120 |
Prophylaxis - child |
5,719 |
5,233 |
$179K |
| D0274 |
Bitewings - four radiographic images |
6,142 |
5,158 |
$170K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,876 |
2,413 |
$147K |
| D0140 |
Limited oral evaluation - problem focused |
3,546 |
3,040 |
$134K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,062 |
473 |
$132K |
| D0210 |
Intraoral - complete series of radiographic images |
1,948 |
1,635 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,357 |
530 |
$123K |
| D4910 |
|
1,527 |
1,267 |
$121K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
592 |
212 |
$90K |
| D1352 |
|
1,470 |
250 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
5,785 |
4,588 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,030 |
2,691 |
$64K |
| D2394 |
|
312 |
187 |
$52K |
| D9920 |
|
1,226 |
1,068 |
$52K |
| D2331 |
|
459 |
252 |
$39K |
| D2950 |
|
196 |
138 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,483 |
1,379 |
$33K |
| D7922 |
|
1,043 |
445 |
$32K |
| D1320 |
|
1,258 |
1,113 |
$30K |
| D2740 |
Crown - porcelain/ceramic |
32 |
13 |
$26K |
| D2330 |
|
258 |
164 |
$22K |
| D2332 |
|
106 |
65 |
$12K |
| D4355 |
|
136 |
124 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
163 |
137 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
194 |
185 |
$6K |
| D2335 |
|
38 |
25 |
$6K |
| D1330 |
|
365 |
354 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
29 |
16 |
$2K |
| D9110 |
|
26 |
25 |
$1K |
| D0240 |
|
51 |
37 |
$1K |
| D7880 |
|
14 |
12 |
$997.00 |
| D1354 |
|
75 |
15 |
$720.00 |
| D0470 |
|
14 |
13 |
$629.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
136 |
128 |
$0.00 |
| D9986 |
|
1,400 |
1,339 |
$0.00 |
| D1999 |
|
472 |
424 |
$0.00 |