| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
71,122 |
70,719 |
$1.85M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20,582 |
10,546 |
$1.44M |
| D0120 |
Periodic oral evaluation - established patient |
78,528 |
78,071 |
$1.23M |
| D1206 |
Topical application of fluoride varnish |
70,094 |
69,679 |
$1.14M |
| D1110 |
Prophylaxis - adult |
18,888 |
18,772 |
$696K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,472 |
2,018 |
$656K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,269 |
4,834 |
$600K |
| D9630 |
|
35,828 |
35,444 |
$540K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,096 |
4,818 |
$482K |
| D1351 |
Sealant - per tooth |
18,382 |
6,392 |
$475K |
| D0272 |
Bitewings - two radiographic images |
28,154 |
27,990 |
$447K |
| D0240 |
|
40,037 |
20,068 |
$379K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,453 |
14,366 |
$362K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,480 |
12,459 |
$357K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,070 |
19,982 |
$341K |
| D9248 |
|
3,506 |
3,350 |
$295K |
| D0274 |
Bitewings - four radiographic images |
9,655 |
9,591 |
$206K |
| D8670 |
Periodic orthodontic treatment visit |
759 |
753 |
$164K |
| D0330 |
Panoramic radiographic image |
3,301 |
3,238 |
$149K |
| D0220 |
Intraoral - periapical first radiographic image |
16,047 |
15,566 |
$140K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,001 |
630 |
$118K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,643 |
6,522 |
$110K |
| D0210 |
Intraoral - complete series of radiographic images |
2,970 |
2,532 |
$88K |
| D9920 |
|
1,343 |
1,337 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
3,067 |
2,983 |
$68K |
| D3120 |
|
3,597 |
1,830 |
$53K |
| D9999 |
Unspecified adjunctive procedure, by report |
159 |
159 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
189 |
101 |
$22K |
| D9310 |
|
220 |
203 |
$18K |
| D9994 |
|
3,083 |
2,954 |
$16K |
| D7880 |
|
52 |
40 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
180 |
97 |
$15K |
| D1354 |
|
1,279 |
487 |
$15K |
| D2330 |
|
203 |
96 |
$12K |
| D2929 |
|
36 |
12 |
$8K |
| D9420 |
|
194 |
194 |
$8K |
| D2332 |
|
80 |
36 |
$4K |
| D4346 |
|
47 |
46 |
$858.90 |
| D8660 |
|
155 |
153 |
$780.00 |