| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
44,507 |
43,331 |
$1.89M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,569 |
9,264 |
$1.65M |
| D0120 |
Periodic oral evaluation - established patient |
38,960 |
38,052 |
$1.26M |
| D1208 |
Topical application of fluoride, excluding varnish |
43,110 |
41,971 |
$1.15M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,933 |
8,859 |
$558K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,573 |
3,761 |
$460K |
| D8670 |
Periodic orthodontic treatment visit |
5,228 |
4,993 |
$371K |
| D1351 |
Sealant - per tooth |
8,705 |
2,869 |
$312K |
| D0274 |
Bitewings - four radiographic images |
6,839 |
6,620 |
$296K |
| D0272 |
Bitewings - two radiographic images |
9,847 |
9,617 |
$292K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,272 |
1,443 |
$289K |
| D0330 |
Panoramic radiographic image |
3,831 |
3,677 |
$283K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,095 |
3,911 |
$244K |
| D0140 |
Limited oral evaluation - problem focused |
3,162 |
3,050 |
$141K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,255 |
897 |
$137K |
| D0220 |
Intraoral - periapical first radiographic image |
7,145 |
6,852 |
$126K |
| D8660 |
|
2,455 |
2,351 |
$76K |
| D7240 |
Removal of impacted tooth - completely bony |
206 |
61 |
$64K |
| D0240 |
|
2,284 |
2,252 |
$41K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
98 |
52 |
$19K |
| D9310 |
|
369 |
340 |
$11K |
| D2394 |
|
60 |
42 |
$10K |
| D7111 |
|
89 |
68 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
366 |
264 |
$6K |
| D9944 |
|
17 |
17 |
$6K |
| D0470 |
|
55 |
39 |
$2K |