| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,025 |
12,739 |
$1.19M |
| D1120 |
Prophylaxis - child |
32,797 |
32,794 |
$1.06M |
| D0120 |
Periodic oral evaluation - established patient |
30,682 |
30,678 |
$671K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,465 |
4,187 |
$447K |
| D1206 |
Topical application of fluoride varnish |
18,134 |
18,071 |
$403K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,653 |
4,423 |
$398K |
| D0272 |
Bitewings - two radiographic images |
30,246 |
30,231 |
$387K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,809 |
7,337 |
$387K |
| D1351 |
Sealant - per tooth |
4,321 |
3,813 |
$311K |
| D0220 |
Intraoral - periapical first radiographic image |
29,452 |
29,215 |
$310K |
| D8670 |
Periodic orthodontic treatment visit |
1,822 |
1,813 |
$301K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,166 |
3,043 |
$227K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,905 |
17,901 |
$196K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,033 |
4,838 |
$190K |
| D0240 |
|
7,977 |
7,977 |
$147K |
| D1110 |
Prophylaxis - adult |
3,381 |
3,381 |
$147K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,962 |
5,962 |
$134K |
| D1354 |
|
3,563 |
2,548 |
$127K |
| D2331 |
|
1,182 |
1,110 |
$97K |
| D0330 |
Panoramic radiographic image |
2,200 |
2,200 |
$63K |
| D8660 |
|
2,140 |
2,136 |
$61K |
| D0340 |
|
1,340 |
1,340 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,158 |
2,158 |
$47K |
| D0470 |
|
1,590 |
1,590 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
3,991 |
3,944 |
$38K |
| D2332 |
|
431 |
403 |
$38K |
| D1510 |
|
388 |
384 |
$32K |
| D9310 |
|
371 |
371 |
$21K |
| D2394 |
|
185 |
182 |
$20K |
| D0350 |
|
1,839 |
1,839 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,107 |
3,101 |
$19K |
| D9110 |
|
876 |
864 |
$18K |
| D0270 |
|
1,249 |
1,240 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
1,286 |
1,277 |
$10K |
| D2330 |
|
99 |
99 |
$5K |
| D9920 |
|
377 |
367 |
$2K |
| D9430 |
|
66 |
64 |
$974.02 |
| D9995 |
|
34 |
32 |
$798.32 |
| D3120 |
|
108 |
108 |
$0.00 |
| D3110 |
|
13 |
12 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$0.00 |
| D1999 |
|
26 |
26 |
$0.00 |