| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,141 |
15,109 |
$646K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,718 |
4,797 |
$470K |
| D8670 |
Periodic orthodontic treatment visit |
2,207 |
1,983 |
$451K |
| D0120 |
Periodic oral evaluation - established patient |
16,354 |
15,391 |
$446K |
| D1351 |
Sealant - per tooth |
5,853 |
3,237 |
$443K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,939 |
13,066 |
$357K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,333 |
2,493 |
$309K |
| D2332 |
|
1,501 |
845 |
$208K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,394 |
3,285 |
$202K |
| D4341 |
|
1,113 |
583 |
$190K |
| D1110 |
Prophylaxis - adult |
3,333 |
3,207 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,669 |
5,304 |
$125K |
| D0210 |
Intraoral - complete series of radiographic images |
4,042 |
3,657 |
$96K |
| D9110 |
|
1,716 |
1,655 |
$92K |
| D0272 |
Bitewings - two radiographic images |
8,805 |
8,176 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
4,260 |
3,954 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,184 |
936 |
$60K |
| D0330 |
Panoramic radiographic image |
3,421 |
3,258 |
$59K |
| D0274 |
Bitewings - four radiographic images |
3,063 |
2,892 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
6,313 |
5,899 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
462 |
360 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,209 |
4,830 |
$22K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
16 |
15 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
190 |
148 |
$11K |
| D2394 |
|
60 |
47 |
$4K |
| D1206 |
Topical application of fluoride varnish |
145 |
145 |
$4K |
| D2330 |
|
69 |
55 |
$3K |
| D8680 |
|
18 |
13 |
$2K |
| D8999 |
|
50 |
45 |
$2K |
| D2331 |
|
39 |
29 |
$2K |
| D8660 |
|
15 |
14 |
$1K |
| D2335 |
|
42 |
30 |
$679.80 |