| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
144,065 |
136,444 |
$4.65M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
39,004 |
14,999 |
$4.07M |
| D0120 |
Periodic oral evaluation - established patient |
145,610 |
138,096 |
$3.46M |
| D1206 |
Topical application of fluoride varnish |
159,226 |
151,081 |
$3.28M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35,137 |
19,403 |
$2.46M |
| D7140 |
Extraction, erupted tooth or exposed root |
33,151 |
15,872 |
$1.82M |
| D8670 |
Periodic orthodontic treatment visit |
19,964 |
15,972 |
$1.58M |
| D9248 |
|
19,640 |
17,907 |
$1.51M |
| D1110 |
Prophylaxis - adult |
31,747 |
30,177 |
$1.31M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18,890 |
12,184 |
$1.10M |
| D1351 |
Sealant - per tooth |
33,808 |
10,758 |
$989K |
| D0210 |
Intraoral - complete series of radiographic images |
17,844 |
16,865 |
$946K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30,292 |
28,600 |
$842K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28,496 |
26,192 |
$797K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
10,352 |
5,030 |
$791K |
| D0272 |
Bitewings - two radiographic images |
52,889 |
49,789 |
$784K |
| D0220 |
Intraoral - periapical first radiographic image |
47,781 |
44,589 |
$556K |
| D0274 |
Bitewings - four radiographic images |
15,430 |
14,668 |
$352K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,875 |
25,464 |
$323K |
| D0330 |
Panoramic radiographic image |
6,728 |
6,345 |
$281K |
| D0140 |
Limited oral evaluation - problem focused |
12,948 |
12,081 |
$276K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,815 |
1,914 |
$224K |
| D1510 |
|
1,430 |
1,073 |
$202K |
| D8660 |
|
4,260 |
4,132 |
$194K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,105 |
9,295 |
$180K |
| D2934 |
|
1,447 |
428 |
$148K |
| D2929 |
|
1,081 |
382 |
$110K |
| D2330 |
|
1,577 |
1,036 |
$84K |
| D2332 |
|
904 |
568 |
$69K |
| D8020 |
|
58 |
52 |
$54K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
39 |
36 |
$48K |
| D1354 |
|
4,563 |
1,657 |
$39K |
| D3230 |
|
682 |
176 |
$38K |
| D7240 |
Removal of impacted tooth - completely bony |
123 |
38 |
$30K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
303 |
251 |
$24K |
| D9222 |
|
271 |
253 |
$22K |
| D2331 |
|
276 |
193 |
$18K |
| D2390 |
|
104 |
76 |
$16K |
| D2931 |
|
117 |
94 |
$15K |
| D7230 |
|
41 |
16 |
$8K |
| D8680 |
|
23 |
12 |
$4K |
| D9612 |
|
83 |
83 |
$3K |
| D1353 |
|
177 |
100 |
$3K |
| D2335 |
|
37 |
31 |
$3K |
| D1517 |
|
13 |
12 |
$3K |
| D9610 |
|
95 |
88 |
$2K |
| D9420 |
|
2,057 |
1,855 |
$725.00 |
| D0160 |
|
338 |
332 |
$647.85 |
| D4346 |
|
66 |
62 |
$131.64 |
| D0270 |
|
14 |
14 |
$59.10 |
| D1330 |
|
251 |
249 |
$0.00 |
| D3110 |
|
18 |
13 |
$0.00 |