| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,371 |
4,105 |
$548K |
| D2740 |
Crown - porcelain/ceramic |
1,083 |
791 |
$497K |
| D8670 |
Periodic orthodontic treatment visit |
6,643 |
6,191 |
$357K |
| D0210 |
Intraoral - complete series of radiographic images |
6,327 |
6,198 |
$331K |
| D1110 |
Prophylaxis - adult |
6,933 |
6,812 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
13,796 |
13,605 |
$264K |
| D1351 |
Sealant - per tooth |
12,990 |
2,140 |
$241K |
| D1120 |
Prophylaxis - child |
7,421 |
7,383 |
$194K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,271 |
1,849 |
$183K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,069 |
929 |
$167K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,184 |
10,967 |
$162K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,885 |
1,240 |
$160K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
261 |
230 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,458 |
5,333 |
$124K |
| D2954 |
|
1,043 |
814 |
$118K |
| D0274 |
Bitewings - four radiographic images |
4,945 |
4,847 |
$88K |
| D7111 |
|
1,541 |
760 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
3,716 |
3,521 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
8,585 |
8,341 |
$61K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
609 |
443 |
$59K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
624 |
448 |
$40K |
| D0272 |
Bitewings - two radiographic images |
3,062 |
3,061 |
$39K |
| D0330 |
Panoramic radiographic image |
1,085 |
1,034 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,507 |
5,740 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
623 |
292 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,460 |
2,350 |
$30K |
| D2332 |
|
346 |
222 |
$28K |
| D9310 |
|
1,201 |
1,191 |
$27K |
| D4355 |
|
439 |
405 |
$19K |
| D4910 |
|
465 |
396 |
$18K |
| D2335 |
|
155 |
69 |
$15K |
| D4341 |
|
138 |
47 |
$13K |
| D8680 |
|
13 |
13 |
$13K |
| D3320 |
|
33 |
27 |
$12K |
| D1206 |
Topical application of fluoride varnish |
1,979 |
1,972 |
$12K |
| D0603 |
|
584 |
584 |
$6K |
| D0602 |
|
526 |
526 |
$5K |
| D2331 |
|
69 |
36 |
$5K |
| D8660 |
|
98 |
98 |
$4K |
| D1353 |
|
343 |
41 |
$3K |
| D3331 |
|
31 |
27 |
$2K |
| D0270 |
|
185 |
185 |
$1K |
| D1510 |
|
13 |
13 |
$1K |
| D2394 |
|
15 |
13 |
$1K |
| D2330 |
|
22 |
15 |
$1K |
| D0240 |
|
87 |
87 |
$710.00 |
| D0350 |
|
485 |
473 |
$445.50 |
| D0601 |
|
16 |
16 |
$140.00 |
| D0171 |
|
16 |
13 |
$60.00 |
| D1999 |
|
140 |
138 |
$0.00 |