| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
115,963 |
115,181 |
$3.65M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
26,301 |
8,135 |
$2.99M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
61,057 |
60,746 |
$2.14M |
| D1208 |
Topical application of fluoride, excluding varnish |
112,805 |
112,029 |
$2.03M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19,753 |
12,064 |
$1.42M |
| D0120 |
Periodic oral evaluation - established patient |
53,579 |
53,344 |
$1.21M |
| D7240 |
Removal of impacted tooth - completely bony |
6,113 |
1,990 |
$1.14M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14,827 |
4,060 |
$1.14M |
| D2934 |
|
7,465 |
1,991 |
$946K |
| D0272 |
Bitewings - two radiographic images |
46,090 |
45,772 |
$934K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
240 |
233 |
$869K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30,352 |
29,361 |
$823K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14,086 |
9,551 |
$767K |
| D1351 |
Sealant - per tooth |
29,523 |
9,055 |
$698K |
| D0274 |
Bitewings - four radiographic images |
19,577 |
19,504 |
$572K |
| D0240 |
|
31,368 |
21,876 |
$473K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,225 |
4,285 |
$473K |
| D0140 |
Limited oral evaluation - problem focused |
13,814 |
13,685 |
$409K |
| D9243 |
|
4,706 |
2,484 |
$387K |
| D0330 |
Panoramic radiographic image |
6,045 |
6,032 |
$308K |
| D9239 |
|
2,523 |
2,477 |
$304K |
| D9420 |
|
3,494 |
3,379 |
$249K |
| D8660 |
|
2,294 |
2,278 |
$237K |
| D7230 |
|
1,450 |
634 |
$229K |
| D0220 |
Intraoral - periapical first radiographic image |
18,224 |
17,969 |
$205K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,162 |
9,706 |
$140K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,130 |
501 |
$127K |
| D9610 |
|
2,435 |
2,394 |
$60K |
| D9248 |
|
2,044 |
1,985 |
$48K |
| D2331 |
|
485 |
252 |
$41K |
| D2330 |
|
315 |
162 |
$21K |
| D1206 |
Topical application of fluoride varnish |
948 |
946 |
$18K |
| D7960 |
|
56 |
45 |
$8K |
| D7111 |
|
150 |
113 |
$7K |
| D7220 |
|
39 |
15 |
$5K |
| D2332 |
|
14 |
12 |
$2K |
| D1110 |
Prophylaxis - adult |
25 |
25 |
$980.26 |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
14 |
$438.47 |
| D0270 |
|
13 |
13 |
$139.24 |
| D1999 |
|
1,174 |
1,052 |
$23.48 |
| D3230 |
|
54 |
15 |
$0.00 |