| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
97,021 |
93,800 |
$3.13M |
| D0120 |
Periodic oral evaluation - established patient |
99,417 |
96,178 |
$2.30M |
| D7240 |
Removal of impacted tooth - completely bony |
5,527 |
1,542 |
$2.02M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24,997 |
16,001 |
$1.39M |
| D8670 |
Periodic orthodontic treatment visit |
25,218 |
22,396 |
$1.37M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37,582 |
34,906 |
$1.29M |
| D8680 |
|
992 |
976 |
$1.15M |
| D1208 |
Topical application of fluoride, excluding varnish |
68,012 |
67,946 |
$1.09M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,480 |
5,483 |
$1.08M |
| D7140 |
Extraction, erupted tooth or exposed root |
10,078 |
6,472 |
$772K |
| D1351 |
Sealant - per tooth |
36,385 |
5,859 |
$766K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
6,010 |
2,086 |
$644K |
| D1206 |
Topical application of fluoride varnish |
40,620 |
37,031 |
$610K |
| D2140 |
|
13,472 |
10,217 |
$585K |
| D0603 |
|
50,740 |
48,926 |
$479K |
| D0272 |
Bitewings - two radiographic images |
39,081 |
37,942 |
$472K |
| D0220 |
Intraoral - periapical first radiographic image |
54,903 |
52,523 |
$450K |
| D1110 |
Prophylaxis - adult |
9,739 |
9,473 |
$412K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
523 |
521 |
$399K |
| D7451 |
|
1,123 |
1,088 |
$390K |
| D0330 |
Panoramic radiographic image |
8,784 |
8,284 |
$369K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,081 |
3,078 |
$323K |
| D9222 |
|
2,129 |
2,080 |
$254K |
| D0274 |
Bitewings - four radiographic images |
17,841 |
17,014 |
$218K |
| D0230 |
Intraoral - periapical each additional radiographic image |
50,406 |
38,272 |
$213K |
| D8660 |
|
5,063 |
4,826 |
$209K |
| D9420 |
|
386 |
379 |
$121K |
| D2160 |
|
1,536 |
1,149 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,902 |
3,758 |
$109K |
| D9310 |
|
4,913 |
4,788 |
$107K |
| D9999 |
Unspecified adjunctive procedure, by report |
256 |
256 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
2,831 |
2,664 |
$74K |
| D0602 |
|
4,615 |
4,615 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
859 |
859 |
$40K |
| D2332 |
|
434 |
301 |
$35K |
| D9248 |
|
118 |
115 |
$32K |
| D2933 |
|
169 |
55 |
$30K |
| D2330 |
|
525 |
375 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,234 |
1,170 |
$18K |
| D2335 |
|
142 |
112 |
$14K |
| D7111 |
|
615 |
462 |
$13K |
| D0270 |
|
1,126 |
957 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
206 |
167 |
$8K |
| D3230 |
|
83 |
27 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
14 |
$6K |
| D1354 |
|
509 |
150 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
49 |
$3K |
| D2331 |
|
37 |
32 |
$2K |
| D9430 |
|
205 |
205 |
$1K |
| D0601 |
|
107 |
107 |
$1K |
| D0170 |
|
73 |
73 |
$1K |
| D8704 |
|
12 |
12 |
$900.00 |
| D9612 |
|
94 |
94 |
$837.00 |
| D9920 |
|
37 |
37 |
$589.00 |
| D9610 |
|
33 |
33 |
$54.00 |
| D1999 |
|
9,283 |
9,085 |
$0.00 |