| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
29,879 |
29,830 |
$954K |
| D1208 |
Topical application of fluoride, excluding varnish |
29,876 |
29,830 |
$546K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,655 |
14,636 |
$515K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
94 |
93 |
$355K |
| D0120 |
Periodic oral evaluation - established patient |
14,995 |
14,972 |
$343K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,991 |
2,695 |
$295K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,386 |
1,276 |
$280K |
| D0272 |
Bitewings - two radiographic images |
12,344 |
12,307 |
$252K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,960 |
7,665 |
$219K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,240 |
2,381 |
$180K |
| D0274 |
Bitewings - four radiographic images |
4,672 |
4,671 |
$138K |
| D0140 |
Limited oral evaluation - problem focused |
3,560 |
3,515 |
$105K |
| D8660 |
|
939 |
938 |
$96K |
| D0220 |
Intraoral - periapical first radiographic image |
8,410 |
8,384 |
$96K |
| D1351 |
Sealant - per tooth |
3,972 |
1,217 |
$96K |
| D0330 |
Panoramic radiographic image |
1,492 |
1,492 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,352 |
6,930 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,053 |
726 |
$70K |
| D0240 |
|
3,286 |
2,131 |
$43K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
372 |
174 |
$30K |
| D9248 |
|
806 |
788 |
$19K |
| D1110 |
Prophylaxis - adult |
113 |
112 |
$5K |
| D2934 |
|
28 |
12 |
$4K |
| D0270 |
|
285 |
283 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
43 |
$3K |
| D7111 |
|
32 |
27 |
$2K |