| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
163,969 |
154,552 |
$4.20M |
| D1110 |
Prophylaxis - adult |
75,554 |
72,169 |
$3.54M |
| D1206 |
Topical application of fluoride varnish |
159,967 |
150,895 |
$3.06M |
| D1120 |
Prophylaxis - child |
85,813 |
80,173 |
$2.91M |
| D0272 |
Bitewings - two radiographic images |
126,300 |
119,720 |
$2.73M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19,584 |
6,558 |
$2.63M |
| D0210 |
Intraoral - complete series of radiographic images |
17,402 |
16,143 |
$1.39M |
| D1351 |
Sealant - per tooth |
49,950 |
15,881 |
$1.31M |
| D8670 |
Periodic orthodontic treatment visit |
11,335 |
6,295 |
$1.17M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14,618 |
9,009 |
$1.11M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45,497 |
40,839 |
$1.10M |
| D7140 |
Extraction, erupted tooth or exposed root |
14,368 |
7,740 |
$891K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,089 |
8,106 |
$886K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,530 |
1,406 |
$874K |
| D2140 |
|
9,268 |
6,498 |
$575K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,783 |
5,101 |
$400K |
| D0220 |
Intraoral - periapical first radiographic image |
21,041 |
19,320 |
$333K |
| D0140 |
Limited oral evaluation - problem focused |
5,531 |
5,043 |
$174K |
| D0240 |
|
6,566 |
6,198 |
$148K |
| D0330 |
Panoramic radiographic image |
7,956 |
7,876 |
$143K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,241 |
4,153 |
$130K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,462 |
738 |
$121K |
| D8999 |
|
78 |
66 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,392 |
6,585 |
$97K |
| D0603 |
|
74,116 |
73,208 |
$59K |
| D8020 |
|
57 |
26 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,638 |
2,635 |
$55K |
| D8030 |
|
79 |
40 |
$51K |
| D2332 |
|
70 |
37 |
$8K |
| D2330 |
|
68 |
44 |
$5K |
| D2160 |
|
53 |
41 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
25 |
$3K |
| D7111 |
|
51 |
28 |
$2K |
| D9248 |
|
19 |
18 |
$2K |
| D0270 |
|
25 |
24 |
$187.60 |
| D0602 |
|
191 |
184 |
$45.00 |
| D8060 |
|
41 |
26 |
$0.00 |