| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
78,712 |
77,961 |
$2.00M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23,420 |
14,059 |
$1.53M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,849 |
1,637 |
$1.32M |
| D1120 |
Prophylaxis - child |
56,003 |
55,356 |
$1.30M |
| D1351 |
Sealant - per tooth |
51,622 |
14,171 |
$1.17M |
| D1208 |
Topical application of fluoride, excluding varnish |
67,206 |
66,524 |
$1.11M |
| D1110 |
Prophylaxis - adult |
26,725 |
26,432 |
$1.02M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16,281 |
9,683 |
$875K |
| D9630 |
|
16,192 |
15,741 |
$683K |
| D0272 |
Bitewings - two radiographic images |
55,724 |
55,177 |
$557K |
| D7240 |
Removal of impacted tooth - completely bony |
3,523 |
1,145 |
$539K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
24,875 |
23,780 |
$526K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,855 |
1,669 |
$501K |
| D0330 |
Panoramic radiographic image |
13,301 |
13,081 |
$489K |
| D9999 |
Unspecified adjunctive procedure, by report |
15,372 |
15,129 |
$452K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,214 |
4,204 |
$373K |
| D1206 |
Topical application of fluoride varnish |
13,583 |
13,341 |
$343K |
| D0240 |
|
36,322 |
18,043 |
$295K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,777 |
2,220 |
$210K |
| D2929 |
|
944 |
274 |
$204K |
| D8670 |
Periodic orthodontic treatment visit |
1,605 |
1,522 |
$191K |
| D0140 |
Limited oral evaluation - problem focused |
8,642 |
8,288 |
$180K |
| D9248 |
|
2,798 |
2,707 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,759 |
3,565 |
$141K |
| D0220 |
Intraoral - periapical first radiographic image |
15,547 |
15,142 |
$126K |
| D1999 |
|
8,981 |
8,522 |
$119K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,155 |
387 |
$100K |
| D7230 |
|
710 |
315 |
$95K |
| D0274 |
Bitewings - four radiographic images |
7,688 |
7,575 |
$88K |
| D2332 |
|
749 |
498 |
$66K |
| D9920 |
|
2,747 |
2,682 |
$66K |
| D0160 |
|
1,854 |
1,792 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,301 |
10,777 |
$49K |
| D2330 |
|
623 |
374 |
$37K |
| D8660 |
|
122 |
113 |
$34K |
| D2331 |
|
150 |
108 |
$11K |
| D9996 |
|
724 |
698 |
$7K |
| D2394 |
|
89 |
75 |
$6K |
| D8030 |
|
16 |
14 |
$3K |
| D7111 |
|
76 |
53 |
$2K |
| D1354 |
|
30 |
12 |
$117.60 |
| D0602 |
|
361 |
360 |
$0.00 |
| D0603 |
|
263 |
261 |
$0.00 |
| D0601 |
|
213 |
210 |
$0.00 |
| D0170 |
|
27 |
26 |
$0.00 |