| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
32,398 |
31,518 |
$828K |
| D1120 |
Prophylaxis - child |
29,828 |
28,863 |
$684K |
| D1206 |
Topical application of fluoride varnish |
34,449 |
33,400 |
$631K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,942 |
1,592 |
$553K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,050 |
4,299 |
$550K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,357 |
1,280 |
$452K |
| D1351 |
Sealant - per tooth |
16,963 |
4,547 |
$400K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,972 |
3,133 |
$288K |
| D1110 |
Prophylaxis - adult |
5,860 |
5,724 |
$229K |
| D0272 |
Bitewings - two radiographic images |
22,073 |
21,463 |
$219K |
| D9999 |
Unspecified adjunctive procedure, by report |
7,347 |
7,091 |
$210K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,419 |
7,636 |
$181K |
| D0330 |
Panoramic radiographic image |
4,476 |
4,383 |
$179K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,065 |
1,743 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,427 |
3,207 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
13,299 |
12,820 |
$108K |
| D8670 |
Periodic orthodontic treatment visit |
412 |
400 |
$91K |
| D0240 |
|
7,242 |
3,486 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
2,723 |
2,588 |
$55K |
| D1999 |
|
3,438 |
3,295 |
$45K |
| D0160 |
|
793 |
762 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,791 |
9,771 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
200 |
96 |
$20K |
| D2331 |
|
98 |
63 |
$11K |
| D2929 |
|
22 |
12 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
58 |
$5K |
| D9248 |
|
91 |
78 |
$4K |
| D1354 |
|
1,250 |
447 |
$4K |
| D1510 |
|
25 |
14 |
$1K |
| D0170 |
|
31 |
31 |
$1K |
| D7111 |
|
21 |
13 |
$574.00 |
| D0602 |
|
23,696 |
23,017 |
$0.00 |
| D0601 |
|
3,956 |
3,750 |
$0.00 |
| D0603 |
|
5,464 |
5,303 |
$0.00 |