| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
32,851 |
32,841 |
$1.41M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,737 |
7,940 |
$1.01M |
| D0120 |
Periodic oral evaluation - established patient |
34,893 |
34,883 |
$968K |
| D1351 |
Sealant - per tooth |
16,975 |
5,906 |
$809K |
| D8670 |
Periodic orthodontic treatment visit |
2,678 |
2,572 |
$562K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,433 |
1,887 |
$469K |
| D1110 |
Prophylaxis - adult |
7,840 |
7,839 |
$429K |
| D1206 |
Topical application of fluoride varnish |
13,741 |
13,729 |
$428K |
| D0272 |
Bitewings - two radiographic images |
23,860 |
23,841 |
$399K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,099 |
26,090 |
$365K |
| D0220 |
Intraoral - periapical first radiographic image |
25,331 |
25,224 |
$345K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,576 |
3,835 |
$317K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,688 |
3,159 |
$302K |
| D0274 |
Bitewings - four radiographic images |
8,737 |
8,729 |
$245K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,134 |
6,134 |
$205K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,881 |
17,554 |
$166K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,356 |
3,972 |
$59K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
486 |
305 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
364 |
276 |
$38K |
| D1354 |
|
765 |
267 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
770 |
766 |
$11K |
| D0340 |
|
295 |
295 |
$11K |
| D8660 |
|
363 |
363 |
$10K |
| D0330 |
Panoramic radiographic image |
329 |
329 |
$10K |
| D0350 |
|
569 |
569 |
$6K |
| D0470 |
|
234 |
232 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
123 |
123 |
$4K |
| D7111 |
|
80 |
65 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
51 |
51 |
$4K |
| D0603 |
|
16,875 |
16,861 |
$4K |
| D2335 |
|
14 |
12 |
$3K |
| D1353 |
|
150 |
54 |
$3K |
| D1510 |
|
13 |
12 |
$2K |
| D1999 |
|
16,983 |
16,142 |
$1K |
| D0602 |
|
2,736 |
2,734 |
$552.00 |
| D0210 |
Intraoral - complete series of radiographic images |
70 |
69 |
$534.11 |
| D0601 |
|
1,020 |
1,019 |
$269.00 |
| D1330 |
|
24,104 |
24,094 |
$200.00 |
| D1310 |
|
727 |
727 |
$0.00 |