| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
94,791 |
94,790 |
$3.96M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35,545 |
24,363 |
$3.96M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18,049 |
12,548 |
$2.95M |
| D1351 |
Sealant - per tooth |
49,797 |
24,989 |
$2.92M |
| D0120 |
Periodic oral evaluation - established patient |
92,541 |
92,536 |
$2.57M |
| D1206 |
Topical application of fluoride varnish |
61,821 |
61,815 |
$1.81M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19,816 |
15,347 |
$1.35M |
| D0230 |
Intraoral - periapical each additional radiographic image |
61,610 |
51,631 |
$1.21M |
| D7140 |
Extraction, erupted tooth or exposed root |
18,889 |
14,002 |
$1.16M |
| D8670 |
Periodic orthodontic treatment visit |
5,483 |
5,458 |
$1.13M |
| D1110 |
Prophylaxis - adult |
17,038 |
17,038 |
$918K |
| D0220 |
Intraoral - periapical first radiographic image |
64,108 |
64,001 |
$864K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
35,391 |
34,990 |
$723K |
| D0330 |
Panoramic radiographic image |
18,379 |
18,378 |
$703K |
| D0272 |
Bitewings - two radiographic images |
40,247 |
40,246 |
$691K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,502 |
4,616 |
$641K |
| D1208 |
Topical application of fluoride, excluding varnish |
45,714 |
45,713 |
$631K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21,284 |
21,284 |
$621K |
| D0274 |
Bitewings - four radiographic images |
19,931 |
19,931 |
$588K |
| D2332 |
|
2,179 |
1,640 |
$277K |
| D2330 |
|
2,612 |
2,038 |
$189K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
236 |
236 |
$188K |
| D8660 |
|
6,548 |
6,546 |
$164K |
| D1510 |
|
1,108 |
1,025 |
$150K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,346 |
1,192 |
$148K |
| D0340 |
|
3,198 |
3,198 |
$147K |
| D7240 |
Removal of impacted tooth - completely bony |
467 |
125 |
$135K |
| D0210 |
Intraoral - complete series of radiographic images |
11,459 |
11,439 |
$117K |
| D2335 |
|
588 |
485 |
$107K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,029 |
3,029 |
$89K |
| D0140 |
Limited oral evaluation - problem focused |
6,626 |
6,587 |
$87K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
329 |
329 |
$80K |
| D0350 |
|
4,099 |
4,099 |
$47K |
| D1354 |
|
1,803 |
617 |
$45K |
| D2331 |
|
389 |
311 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
462 |
246 |
$35K |
| D9222 |
|
269 |
269 |
$19K |
| D2390 |
|
198 |
118 |
$19K |
| D2140 |
|
97 |
61 |
$5K |
| D2933 |
|
13 |
13 |
$4K |
| D9995 |
|
37 |
37 |
$845.28 |
| D1330 |
|
251 |
251 |
$0.00 |