| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
68,752 |
68,649 |
$2.20M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,148 |
2,902 |
$1.43M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,932 |
11,289 |
$1.23M |
| D1208 |
Topical application of fluoride, excluding varnish |
65,782 |
65,677 |
$1.20M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32,414 |
32,360 |
$1.15M |
| D0120 |
Periodic oral evaluation - established patient |
38,072 |
38,027 |
$872K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,898 |
8,064 |
$710K |
| D0272 |
Bitewings - two radiographic images |
31,262 |
31,212 |
$644K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20,702 |
20,092 |
$569K |
| D0274 |
Bitewings - four radiographic images |
17,625 |
17,593 |
$523K |
| D1351 |
Sealant - per tooth |
20,368 |
6,676 |
$488K |
| D0220 |
Intraoral - periapical first radiographic image |
41,181 |
41,071 |
$472K |
| D0230 |
Intraoral - periapical each additional radiographic image |
39,990 |
39,207 |
$374K |
| D0210 |
Intraoral - complete series of radiographic images |
6,322 |
6,237 |
$365K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,575 |
1,056 |
$288K |
| D8660 |
|
2,425 |
2,422 |
$254K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
67 |
67 |
$254K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,274 |
1,878 |
$218K |
| D0140 |
Limited oral evaluation - problem focused |
5,091 |
5,002 |
$152K |
| D9420 |
|
1,945 |
1,896 |
$142K |
| D0240 |
|
6,938 |
4,663 |
$97K |
| D0330 |
Panoramic radiographic image |
2,019 |
2,015 |
$92K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
938 |
779 |
$82K |
| D2929 |
|
634 |
192 |
$78K |
| D1206 |
Topical application of fluoride varnish |
3,538 |
3,537 |
$69K |
| D1110 |
Prophylaxis - adult |
1,681 |
1,678 |
$67K |
| D2934 |
|
370 |
89 |
$46K |
| D7111 |
|
603 |
427 |
$29K |
| D2330 |
|
299 |
174 |
$21K |
| D9248 |
|
61 |
61 |
$1K |
| D2331 |
|
15 |
14 |
$1K |