| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
62,630 |
62,449 |
$1.98M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,405 |
5,981 |
$1.89M |
| D0120 |
Periodic oral evaluation - established patient |
68,529 |
68,327 |
$1.55M |
| D1208 |
Topical application of fluoride, excluding varnish |
71,919 |
71,688 |
$1.30M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
334 |
329 |
$1.21M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,469 |
6,651 |
$661K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,176 |
4,635 |
$523K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,494 |
17,190 |
$476K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,615 |
2,579 |
$446K |
| D0272 |
Bitewings - two radiographic images |
22,157 |
22,091 |
$446K |
| D0274 |
Bitewings - four radiographic images |
15,044 |
14,978 |
$436K |
| D1110 |
Prophylaxis - adult |
13,297 |
13,253 |
$436K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,669 |
5,385 |
$402K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,561 |
9,527 |
$331K |
| D2929 |
|
2,459 |
581 |
$289K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,355 |
9,797 |
$254K |
| D8660 |
|
2,081 |
2,077 |
$210K |
| D0330 |
Panoramic radiographic image |
4,790 |
4,779 |
$208K |
| D0140 |
Limited oral evaluation - problem focused |
5,913 |
5,872 |
$174K |
| D0220 |
Intraoral - periapical first radiographic image |
14,066 |
13,946 |
$159K |
| D9420 |
|
1,303 |
1,300 |
$97K |
| D1351 |
Sealant - per tooth |
680 |
187 |
$15K |
| D1510 |
|
114 |
87 |
$14K |
| D0240 |
|
1,362 |
1,189 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
181 |
168 |
$5K |
| D1354 |
|
148 |
52 |
$4K |