| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
22,177 |
21,993 |
$1.01M |
| D1206 |
Topical application of fluoride varnish |
53,196 |
52,723 |
$1.01M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,895 |
5,549 |
$1.00M |
| D0120 |
Periodic oral evaluation - established patient |
40,435 |
40,070 |
$968K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
369 |
367 |
$903K |
| D1120 |
Prophylaxis - child |
26,421 |
26,165 |
$885K |
| D1351 |
Sealant - per tooth |
20,174 |
8,181 |
$713K |
| D8660 |
|
4,953 |
4,928 |
$692K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,203 |
2,524 |
$652K |
| D0350 |
|
13,150 |
9,859 |
$496K |
| D0274 |
Bitewings - four radiographic images |
16,141 |
15,989 |
$488K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,976 |
16,711 |
$448K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,622 |
13,088 |
$426K |
| D2140 |
|
4,691 |
3,272 |
$417K |
| D0272 |
Bitewings - two radiographic images |
15,764 |
15,611 |
$333K |
| D0330 |
Panoramic radiographic image |
5,679 |
5,611 |
$298K |
| D0220 |
Intraoral - periapical first radiographic image |
21,923 |
21,694 |
$279K |
| D8670 |
Periodic orthodontic treatment visit |
2,093 |
2,086 |
$264K |
| D0340 |
|
4,083 |
4,051 |
$238K |
| D1353 |
|
6,543 |
2,937 |
$229K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,965 |
1,355 |
$202K |
| D7240 |
Removal of impacted tooth - completely bony |
677 |
223 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,845 |
3,825 |
$154K |
| D2160 |
|
1,064 |
731 |
$153K |
| D0470 |
|
2,849 |
2,836 |
$134K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,006 |
607 |
$101K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,565 |
1,558 |
$50K |
| D7111 |
|
899 |
569 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,247 |
1,223 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
275 |
202 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
2,775 |
2,716 |
$30K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
354 |
234 |
$30K |
| D8680 |
|
92 |
86 |
$21K |
| D9248 |
|
70 |
68 |
$10K |
| D0273 |
|
234 |
234 |
$6K |
| D0603 |
|
165 |
165 |
$2K |
| D1330 |
|
165 |
165 |
$2K |
| D9219 |
|
25 |
25 |
$1K |