| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26,144 |
13,498 |
$1.82M |
| D1120 |
Prophylaxis - child |
29,103 |
28,799 |
$1.23M |
| D1351 |
Sealant - per tooth |
45,072 |
10,043 |
$1.04M |
| D0120 |
Periodic oral evaluation - established patient |
38,530 |
38,146 |
$1.01M |
| D1110 |
Prophylaxis - adult |
22,072 |
21,902 |
$1.00M |
| D1206 |
Topical application of fluoride varnish |
34,067 |
33,706 |
$869K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,373 |
1,084 |
$735K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,246 |
6,676 |
$645K |
| D0330 |
Panoramic radiographic image |
12,896 |
12,691 |
$416K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,495 |
2,986 |
$373K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
625 |
575 |
$339K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,832 |
11,757 |
$296K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,540 |
2,566 |
$260K |
| D8670 |
Periodic orthodontic treatment visit |
4,970 |
4,712 |
$251K |
| D0230 |
Intraoral - periapical each additional radiographic image |
65,287 |
42,438 |
$240K |
| D0220 |
Intraoral - periapical first radiographic image |
46,354 |
45,359 |
$221K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,595 |
10,810 |
$211K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,434 |
1,604 |
$204K |
| D9310 |
|
14,168 |
13,947 |
$204K |
| D0274 |
Bitewings - four radiographic images |
17,889 |
17,723 |
$186K |
| D0603 |
|
28,623 |
28,263 |
$181K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,620 |
6,528 |
$168K |
| D0210 |
Intraoral - complete series of radiographic images |
3,298 |
3,284 |
$153K |
| D7250 |
|
1,489 |
733 |
$144K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,137 |
646 |
$118K |
| D0272 |
Bitewings - two radiographic images |
15,273 |
15,114 |
$110K |
| D2954 |
|
810 |
672 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
2,829 |
2,773 |
$60K |
| D9920 |
|
2,857 |
2,686 |
$59K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
81 |
80 |
$53K |
| D0340 |
|
2,596 |
2,550 |
$35K |
| D4341 |
|
273 |
99 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
786 |
775 |
$14K |
| D7230 |
|
46 |
25 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
141 |
90 |
$9K |
| D2950 |
|
192 |
148 |
$9K |
| D2330 |
|
165 |
96 |
$8K |
| D2335 |
|
97 |
72 |
$8K |
| D2332 |
|
88 |
53 |
$5K |
| D0602 |
|
491 |
491 |
$5K |
| D1353 |
|
446 |
88 |
$4K |
| D0601 |
|
428 |
426 |
$4K |
| D2331 |
|
63 |
43 |
$4K |
| D0350 |
|
3,111 |
3,040 |
$3K |
| D4355 |
|
12 |
12 |
$1K |
| D8660 |
|
1,288 |
1,251 |
$810.00 |
| D7111 |
|
17 |
15 |
$765.00 |
| D9945 |
|
12 |
12 |
$360.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
24 |
15 |
$0.00 |