| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
78,407 |
70,716 |
$3.11M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26,992 |
15,470 |
$2.41M |
| D1206 |
Topical application of fluoride varnish |
72,594 |
65,484 |
$1.77M |
| D0120 |
Periodic oral evaluation - established patient |
53,505 |
49,607 |
$1.60M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31,432 |
28,240 |
$1.53M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20,080 |
12,659 |
$1.51M |
| D0330 |
Panoramic radiographic image |
23,951 |
21,029 |
$1.33M |
| D1351 |
Sealant - per tooth |
34,563 |
9,989 |
$1.23M |
| D8670 |
Periodic orthodontic treatment visit |
17,172 |
16,577 |
$1.13M |
| D0274 |
Bitewings - four radiographic images |
32,242 |
29,216 |
$1.07M |
| D0272 |
Bitewings - two radiographic images |
26,535 |
23,654 |
$660K |
| D0220 |
Intraoral - periapical first radiographic image |
36,998 |
33,248 |
$504K |
| D0140 |
Limited oral evaluation - problem focused |
11,971 |
10,991 |
$372K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,323 |
20,979 |
$367K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,747 |
2,259 |
$344K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,137 |
2,259 |
$339K |
| D1110 |
Prophylaxis - adult |
9,457 |
8,724 |
$289K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,783 |
417 |
$283K |
| D7240 |
Removal of impacted tooth - completely bony |
802 |
226 |
$219K |
| D2991 |
|
3,175 |
351 |
$176K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,574 |
6,791 |
$171K |
| D8660 |
|
5,976 |
5,411 |
$126K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
929 |
300 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,187 |
1,363 |
$80K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,043 |
416 |
$77K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
139 |
138 |
$68K |
| D7111 |
|
597 |
381 |
$49K |
| D7230 |
|
161 |
75 |
$35K |
| D2335 |
|
191 |
122 |
$24K |
| D2934 |
|
70 |
25 |
$21K |
| D2332 |
|
138 |
89 |
$18K |
| D2330 |
|
124 |
85 |
$9K |
| D0470 |
|
94 |
93 |
$8K |
| D2140 |
|
153 |
120 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
93 |
70 |
$7K |
| D2331 |
|
54 |
37 |
$5K |
| D0270 |
|
356 |
338 |
$2K |
| D3120 |
|
22 |
19 |
$0.00 |
| D1999 |
|
12,617 |
10,730 |
$0.00 |
| D0350 |
|
95 |
95 |
$0.00 |