| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
126,104 |
126,100 |
$5.29M |
| D0120 |
Periodic oral evaluation - established patient |
144,804 |
144,801 |
$3.68M |
| D1351 |
Sealant - per tooth |
60,819 |
24,865 |
$2.79M |
| D1208 |
Topical application of fluoride, excluding varnish |
166,082 |
166,053 |
$2.32M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15,556 |
9,026 |
$2.07M |
| D1110 |
Prophylaxis - adult |
41,692 |
41,692 |
$1.96M |
| D8670 |
Periodic orthodontic treatment visit |
7,565 |
7,540 |
$1.82M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20,818 |
14,817 |
$1.58M |
| D0272 |
Bitewings - two radiographic images |
96,580 |
96,576 |
$1.39M |
| D0220 |
Intraoral - periapical first radiographic image |
135,951 |
135,765 |
$1.18M |
| D0230 |
Intraoral - periapical each additional radiographic image |
149,373 |
148,382 |
$1.07M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19,310 |
13,836 |
$1.04M |
| D0274 |
Bitewings - four radiographic images |
41,401 |
41,401 |
$1.03M |
| D7140 |
Extraction, erupted tooth or exposed root |
16,184 |
11,471 |
$888K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
764 |
764 |
$662K |
| D2335 |
|
2,933 |
836 |
$374K |
| D9994 |
|
24,453 |
24,383 |
$352K |
| D9993 |
|
24,446 |
24,375 |
$352K |
| D1354 |
|
13,874 |
5,311 |
$348K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,247 |
11,247 |
$321K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,483 |
932 |
$251K |
| D0340 |
|
5,424 |
5,423 |
$246K |
| D0145 |
Oral evaluation for a patient under three years of age |
8,225 |
8,225 |
$245K |
| D1310 |
|
24,538 |
24,465 |
$222K |
| D1330 |
|
24,514 |
24,442 |
$222K |
| D8660 |
|
6,623 |
6,622 |
$190K |
| D0330 |
Panoramic radiographic image |
4,153 |
4,152 |
$134K |
| D1206 |
Topical application of fluoride varnish |
3,213 |
3,213 |
$96K |
| D0350 |
|
7,863 |
7,861 |
$91K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,337 |
2,261 |
$74K |
| D0603 |
|
10,138 |
10,115 |
$63K |
| D9420 |
|
604 |
604 |
$44K |
| D8020 |
|
44 |
44 |
$43K |
| D0240 |
|
2,348 |
2,261 |
$40K |
| D0470 |
|
1,375 |
1,375 |
$40K |
| D0601 |
|
4,686 |
4,686 |
$36K |
| D0602 |
|
4,711 |
4,711 |
$34K |
| D8680 |
|
198 |
198 |
$34K |
| D2330 |
|
517 |
308 |
$30K |
| D8060 |
|
27 |
27 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
1,744 |
1,742 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
185 |
154 |
$15K |
| D2332 |
|
73 |
51 |
$8K |
| D9110 |
|
109 |
109 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
162 |
159 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$800.00 |