| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
57,269 |
57,055 |
$1.81M |
| D1208 |
Topical application of fluoride, excluding varnish |
56,558 |
56,346 |
$1.02M |
| D0120 |
Periodic oral evaluation - established patient |
38,994 |
38,824 |
$885K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,880 |
7,537 |
$862K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18,801 |
18,766 |
$650K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,255 |
16,581 |
$468K |
| D0272 |
Bitewings - two radiographic images |
21,073 |
21,003 |
$430K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,601 |
5,465 |
$412K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,370 |
2,009 |
$397K |
| D0274 |
Bitewings - four radiographic images |
11,596 |
11,567 |
$344K |
| D1351 |
Sealant - per tooth |
9,482 |
2,896 |
$226K |
| D0220 |
Intraoral - periapical first radiographic image |
15,091 |
14,990 |
$175K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
37 |
37 |
$142K |
| D0140 |
Limited oral evaluation - problem focused |
4,790 |
4,712 |
$141K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,460 |
12,339 |
$117K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,779 |
1,210 |
$117K |
| D8660 |
|
1,061 |
1,059 |
$108K |
| D0330 |
Panoramic radiographic image |
2,071 |
2,060 |
$102K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
719 |
596 |
$62K |
| D0240 |
|
3,331 |
2,575 |
$54K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
358 |
238 |
$29K |
| D7111 |
|
388 |
279 |
$19K |
| D1206 |
Topical application of fluoride varnish |
545 |
545 |
$10K |
| D9248 |
|
432 |
424 |
$10K |
| D1110 |
Prophylaxis - adult |
140 |
140 |
$6K |
| D9420 |
|
26 |
25 |
$2K |
| D1999 |
|
116 |
112 |
$0.00 |