| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
53,515 |
48,992 |
$2.17M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18,013 |
9,985 |
$1.60M |
| D1206 |
Topical application of fluoride varnish |
50,136 |
46,030 |
$1.26M |
| D0120 |
Periodic oral evaluation - established patient |
39,775 |
36,511 |
$1.19M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21,992 |
19,674 |
$1.08M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14,156 |
8,100 |
$1.04M |
| D8670 |
Periodic orthodontic treatment visit |
15,792 |
14,947 |
$973K |
| D0330 |
Panoramic radiographic image |
17,343 |
15,485 |
$950K |
| D1351 |
Sealant - per tooth |
24,576 |
7,300 |
$876K |
| D0274 |
Bitewings - four radiographic images |
20,552 |
18,783 |
$679K |
| D0272 |
Bitewings - two radiographic images |
19,222 |
17,532 |
$488K |
| D7240 |
Removal of impacted tooth - completely bony |
2,135 |
512 |
$456K |
| D0220 |
Intraoral - periapical first radiographic image |
28,663 |
25,455 |
$388K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,195 |
1,813 |
$283K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,638 |
16,402 |
$282K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,603 |
1,761 |
$279K |
| D0140 |
Limited oral evaluation - problem focused |
8,250 |
7,451 |
$253K |
| D1110 |
Prophylaxis - adult |
5,673 |
5,218 |
$177K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,422 |
668 |
$149K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,888 |
1,855 |
$108K |
| D7111 |
|
1,353 |
744 |
$103K |
| D7230 |
|
482 |
252 |
$103K |
| D2991 |
|
1,683 |
281 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,850 |
3,351 |
$86K |
| D2335 |
|
277 |
161 |
$40K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
48 |
40 |
$21K |
| D2332 |
|
111 |
49 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
143 |
50 |
$11K |
| D2394 |
|
64 |
53 |
$10K |
| D0470 |
|
100 |
94 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
63 |
37 |
$5K |
| D0270 |
|
798 |
693 |
$4K |
| D2330 |
|
58 |
29 |
$4K |
| D2331 |
|
39 |
27 |
$4K |
| D7250 |
|
17 |
12 |
$3K |
| D8660 |
|
156 |
153 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
12 |
$889.20 |
| D1999 |
|
9,480 |
7,430 |
$0.00 |