| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
27,877 |
27,472 |
$949K |
| D1351 |
Sealant - per tooth |
31,227 |
6,406 |
$623K |
| D1206 |
Topical application of fluoride varnish |
29,206 |
28,829 |
$606K |
| D0120 |
Periodic oral evaluation - established patient |
22,710 |
22,368 |
$595K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,589 |
3,775 |
$360K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,720 |
2,858 |
$235K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,477 |
3,019 |
$202K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,392 |
7,090 |
$128K |
| D0330 |
Panoramic radiographic image |
3,471 |
3,439 |
$116K |
| D0602 |
|
11,883 |
11,769 |
$105K |
| D8670 |
Periodic orthodontic treatment visit |
1,775 |
1,709 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,811 |
3,784 |
$89K |
| D0272 |
Bitewings - two radiographic images |
9,038 |
8,976 |
$84K |
| D1110 |
Prophylaxis - adult |
2,376 |
2,332 |
$81K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
622 |
380 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
2,044 |
2,016 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
11,582 |
11,303 |
$60K |
| D7111 |
|
1,278 |
875 |
$59K |
| D0603 |
|
5,085 |
5,052 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,643 |
10,276 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,757 |
1,738 |
$30K |
| D9248 |
|
191 |
190 |
$23K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
31 |
30 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
398 |
279 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
726 |
723 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
131 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
241 |
241 |
$8K |
| D9310 |
|
572 |
570 |
$8K |
| D9920 |
|
313 |
300 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$5K |
| D2330 |
|
88 |
68 |
$4K |
| D8660 |
|
89 |
89 |
$4K |
| D2331 |
|
17 |
14 |
$1K |
| D0601 |
|
70 |
70 |
$660.00 |
| D1353 |
|
45 |
12 |
$440.00 |
| D1999 |
|
2,809 |
2,661 |
$0.00 |