| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,276 |
8,968 |
$374K |
| D4341 |
|
2,226 |
1,220 |
$364K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,253 |
4,050 |
$356K |
| D8670 |
Periodic orthodontic treatment visit |
1,594 |
1,531 |
$310K |
| D0120 |
Periodic oral evaluation - established patient |
9,179 |
8,883 |
$250K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,867 |
2,054 |
$235K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,593 |
6,351 |
$168K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,356 |
6,997 |
$168K |
| D1351 |
Sealant - per tooth |
1,749 |
1,025 |
$139K |
| D1110 |
Prophylaxis - adult |
3,335 |
3,205 |
$136K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,312 |
1,645 |
$134K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,583 |
1,271 |
$133K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,812 |
2,265 |
$122K |
| D0274 |
Bitewings - four radiographic images |
6,978 |
6,678 |
$111K |
| D0140 |
Limited oral evaluation - problem focused |
4,160 |
3,955 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
12,241 |
11,644 |
$70K |
| D2740 |
Crown - porcelain/ceramic |
246 |
224 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,047 |
954 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,358 |
9,609 |
$49K |
| D0330 |
Panoramic radiographic image |
2,535 |
2,428 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
2,974 |
2,794 |
$44K |
| D1206 |
Topical application of fluoride varnish |
1,636 |
1,595 |
$43K |
| D2950 |
|
341 |
324 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,278 |
1,229 |
$13K |
| D2332 |
|
139 |
114 |
$11K |
| D2750 |
|
43 |
36 |
$11K |
| D9310 |
|
647 |
637 |
$11K |
| D9110 |
|
155 |
134 |
$8K |
| D8999 |
|
184 |
171 |
$6K |
| D2330 |
|
102 |
89 |
$5K |
| D5110 |
|
12 |
12 |
$5K |
| D2331 |
|
60 |
54 |
$5K |
| D4910 |
|
57 |
56 |
$4K |
| D2394 |
|
34 |
31 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
28 |
$2K |
| D2335 |
|
21 |
13 |
$2K |
| D0270 |
|
101 |
100 |
$565.60 |