| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
160,727 |
159,424 |
$7.13M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58,125 |
32,039 |
$6.29M |
| D0120 |
Periodic oral evaluation - established patient |
147,309 |
146,369 |
$4.98M |
| D1208 |
Topical application of fluoride, excluding varnish |
159,003 |
157,708 |
$4.45M |
| D8670 |
Periodic orthodontic treatment visit |
38,466 |
37,712 |
$2.89M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20,722 |
14,247 |
$1.86M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27,394 |
24,639 |
$1.51M |
| D1351 |
Sealant - per tooth |
36,614 |
12,414 |
$1.40M |
| D0272 |
Bitewings - two radiographic images |
45,240 |
44,922 |
$1.39M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
9,819 |
7,442 |
$1.35M |
| D0330 |
Panoramic radiographic image |
14,661 |
14,551 |
$1.22M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,262 |
1,252 |
$733K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,706 |
11,441 |
$718K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,581 |
1,834 |
$701K |
| D0274 |
Bitewings - four radiographic images |
11,420 |
11,350 |
$528K |
| D0220 |
Intraoral - periapical first radiographic image |
24,970 |
24,560 |
$457K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,754 |
2,346 |
$412K |
| D0140 |
Limited oral evaluation - problem focused |
7,644 |
7,559 |
$352K |
| D7111 |
|
4,016 |
2,576 |
$343K |
| D8660 |
|
5,683 |
5,552 |
$182K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,502 |
8,155 |
$155K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
126 |
126 |
$150K |
| D0470 |
|
1,564 |
1,530 |
$137K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
656 |
409 |
$83K |
| D8020 |
|
84 |
84 |
$59K |
| D2335 |
|
214 |
133 |
$43K |
| D2332 |
|
168 |
118 |
$27K |
| D2394 |
|
82 |
65 |
$16K |
| D9222 |
|
126 |
126 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
88 |
88 |
$9K |
| D8703 |
|
36 |
25 |
$5K |
| D8999 |
|
14 |
14 |
$2K |
| D3110 |
|
19 |
16 |
$2K |
| D1354 |
|
155 |
37 |
$2K |
| D0270 |
|
121 |
120 |
$2K |