| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,272 |
17,122 |
$571K |
| D8670 |
Periodic orthodontic treatment visit |
1,234 |
1,187 |
$488K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,630 |
2,452 |
$406K |
| D0120 |
Periodic oral evaluation - established patient |
17,967 |
17,811 |
$357K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,423 |
16,270 |
$337K |
| D1110 |
Prophylaxis - adult |
3,724 |
3,687 |
$173K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,961 |
4,556 |
$165K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,141 |
651 |
$155K |
| D1351 |
Sealant - per tooth |
4,871 |
1,602 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,100 |
1,287 |
$154K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,194 |
1,276 |
$147K |
| D0272 |
Bitewings - two radiographic images |
7,036 |
6,966 |
$140K |
| D1206 |
Topical application of fluoride varnish |
4,558 |
4,525 |
$94K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
69 |
57 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
5,841 |
5,711 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,735 |
4,612 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,452 |
1,442 |
$40K |
| D8660 |
|
213 |
213 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,028 |
1,017 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,614 |
1,610 |
$32K |
| D0330 |
Panoramic radiographic image |
584 |
574 |
$31K |
| D9920 |
|
449 |
408 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
879 |
856 |
$21K |
| D0240 |
|
1,468 |
780 |
$18K |
| D8680 |
|
13 |
13 |
$5K |
| D3120 |
|
290 |
206 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
13 |
$1K |
| D1354 |
|
113 |
25 |
$1K |