| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,549 |
2,131 |
$478K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,716 |
1,697 |
$309K |
| D0140 |
Limited oral evaluation - problem focused |
10,545 |
7,187 |
$270K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
545 |
411 |
$231K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,349 |
204 |
$178K |
| D1120 |
Prophylaxis - child |
8,063 |
6,346 |
$173K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,556 |
1,095 |
$167K |
| D0330 |
Panoramic radiographic image |
4,569 |
3,719 |
$142K |
| D1351 |
Sealant - per tooth |
5,397 |
778 |
$123K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,021 |
500 |
$109K |
| D8670 |
Periodic orthodontic treatment visit |
1,787 |
1,121 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
4,584 |
3,877 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,515 |
5,053 |
$77K |
| D2931 |
|
614 |
407 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
7,518 |
5,954 |
$66K |
| D0274 |
Bitewings - four radiographic images |
3,131 |
2,624 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,148 |
3,776 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
739 |
586 |
$43K |
| D0272 |
Bitewings - two radiographic images |
3,319 |
2,541 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,028 |
825 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,255 |
1,031 |
$26K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
25 |
14 |
$14K |
| D9310 |
|
232 |
209 |
$10K |
| D2332 |
|
128 |
50 |
$8K |
| D2330 |
|
107 |
40 |
$7K |
| D1110 |
Prophylaxis - adult |
475 |
365 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
463 |
297 |
$4K |
| D2335 |
|
36 |
12 |
$3K |
| D0340 |
|
45 |
38 |
$2K |