| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,095 |
16,788 |
$566K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,676 |
2,429 |
$408K |
| D1206 |
Topical application of fluoride varnish |
17,035 |
16,708 |
$351K |
| D0120 |
Periodic oral evaluation - established patient |
16,814 |
16,493 |
$333K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,804 |
576 |
$244K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,833 |
1,274 |
$189K |
| D9630 |
|
9,132 |
8,890 |
$181K |
| D1110 |
Prophylaxis - adult |
3,819 |
3,741 |
$175K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,163 |
5,084 |
$160K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,863 |
1,137 |
$137K |
| D0240 |
|
10,805 |
5,318 |
$131K |
| D0272 |
Bitewings - two radiographic images |
6,361 |
6,237 |
$127K |
| D1351 |
Sealant - per tooth |
3,943 |
1,344 |
$125K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,143 |
2,830 |
$106K |
| D9248 |
|
858 |
806 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,982 |
3,925 |
$82K |
| D0274 |
Bitewings - four radiographic images |
2,050 |
2,008 |
$55K |
| D8670 |
Periodic orthodontic treatment visit |
131 |
119 |
$53K |
| D0330 |
Panoramic radiographic image |
886 |
867 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
4,047 |
3,924 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
1,035 |
889 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,086 |
1,535 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
229 |
161 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
854 |
812 |
$21K |
| D9999 |
Unspecified adjunctive procedure, by report |
115 |
111 |
$18K |
| D3120 |
|
878 |
490 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
127 |
64 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
67 |
25 |
$8K |
| D9310 |
|
65 |
65 |
$5K |
| D2950 |
|
17 |
13 |
$2K |
| D9420 |
|
29 |
29 |
$2K |
| D9920 |
|
26 |
26 |
$2K |
| D9994 |
|
205 |
198 |
$2K |
| D1354 |
|
119 |
50 |
$1K |