| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,688 |
10,641 |
$444K |
| D1206 |
Topical application of fluoride varnish |
14,394 |
11,397 |
$382K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,736 |
5,343 |
$368K |
| D0140 |
Limited oral evaluation - problem focused |
9,614 |
8,347 |
$271K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,749 |
7,796 |
$216K |
| D1351 |
Sealant - per tooth |
12,783 |
2,461 |
$216K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,044 |
653 |
$212K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,820 |
1,429 |
$162K |
| D2950 |
|
3,095 |
1,983 |
$153K |
| D0330 |
Panoramic radiographic image |
5,834 |
4,622 |
$144K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,655 |
2,896 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
6,911 |
5,439 |
$114K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,800 |
2,596 |
$112K |
| D0272 |
Bitewings - two radiographic images |
8,028 |
6,211 |
$101K |
| D9310 |
|
1,223 |
1,081 |
$87K |
| D0274 |
Bitewings - four radiographic images |
5,076 |
4,026 |
$85K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,649 |
955 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,550 |
4,162 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
8,232 |
6,492 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,475 |
6,884 |
$67K |
| D0240 |
|
9,542 |
3,549 |
$62K |
| D0190 |
|
4,700 |
4,246 |
$55K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
19 |
12 |
$26K |
| D9248 |
|
327 |
271 |
$23K |
| D1110 |
Prophylaxis - adult |
1,199 |
1,064 |
$19K |
| D8660 |
|
630 |
430 |
$17K |
| D0340 |
|
674 |
425 |
$14K |
| D9999 |
Unspecified adjunctive procedure, by report |
421 |
421 |
$14K |
| D1354 |
|
1,275 |
391 |
$10K |
| D0999 |
Unspecified diagnostic procedure, by report |
298 |
298 |
$9K |
| D0270 |
|
1,823 |
1,504 |
$9K |
| D0350 |
|
674 |
423 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
345 |
312 |
$6K |
| D3110 |
|
313 |
241 |
$4K |
| D0383 |
|
250 |
125 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
90 |
51 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
95 |
93 |
$3K |
| D0601 |
|
453 |
436 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
127 |
108 |
$1K |
| D0602 |
|
301 |
286 |
$1K |
| D4910 |
|
1,998 |
1,792 |
$1K |
| D4341 |
|
590 |
339 |
$1K |
| D1999 |
|
69 |
69 |
$1K |
| D0460 |
|
561 |
455 |
$817.95 |
| D4342 |
|
587 |
313 |
$494.00 |
| D2331 |
|
112 |
79 |
$379.25 |
| D9110 |
|
17 |
13 |
$346.99 |
| D9239 |
|
12 |
12 |
$277.65 |
| D9243 |
|
12 |
12 |
$271.18 |
| D1208 |
Topical application of fluoride, excluding varnish |
95 |
27 |
$235.52 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
33 |
25 |
$195.00 |
| D0603 |
|
160 |
144 |
$128.00 |
| D4346 |
|
14 |
12 |
$53.00 |
| D1330 |
|
531 |
445 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
14 |
13 |
$0.00 |
| D0391 |
|
38 |
35 |
$0.00 |