| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
182,812 |
168,090 |
$6.91M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
76,219 |
40,317 |
$4.37M |
| D1110 |
Prophylaxis - adult |
85,365 |
77,923 |
$4.37M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
58,011 |
53,196 |
$2.73M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17,542 |
9,115 |
$2.41M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18,786 |
12,114 |
$2.10M |
| D0120 |
Periodic oral evaluation - established patient |
208,597 |
191,612 |
$1.83M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
51,391 |
44,137 |
$1.62M |
| D0274 |
Bitewings - four radiographic images |
89,822 |
82,196 |
$1.11M |
| D0330 |
Panoramic radiographic image |
15,636 |
14,541 |
$842K |
| D1351 |
Sealant - per tooth |
118,722 |
28,272 |
$599K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20,332 |
12,258 |
$546K |
| D0220 |
Intraoral - periapical first radiographic image |
230,829 |
211,293 |
$529K |
| D0230 |
Intraoral - periapical each additional radiographic image |
221,890 |
195,533 |
$490K |
| D7140 |
Extraction, erupted tooth or exposed root |
24,583 |
13,738 |
$489K |
| D7240 |
Removal of impacted tooth - completely bony |
3,172 |
1,076 |
$443K |
| D1510 |
|
1,317 |
938 |
$417K |
| D0210 |
Intraoral - complete series of radiographic images |
6,351 |
6,047 |
$414K |
| D9243 |
|
860 |
651 |
$409K |
| D1208 |
Topical application of fluoride, excluding varnish |
160,117 |
143,648 |
$391K |
| D1206 |
Topical application of fluoride varnish |
105,875 |
100,325 |
$372K |
| D9920 |
|
5,596 |
5,004 |
$342K |
| D0272 |
Bitewings - two radiographic images |
115,353 |
106,143 |
$318K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
548 |
381 |
$311K |
| D1330 |
|
255,342 |
234,057 |
$284K |
| D0140 |
Limited oral evaluation - problem focused |
15,864 |
14,598 |
$255K |
| D0601 |
|
6,783 |
6,325 |
$198K |
| D9420 |
|
734 |
625 |
$194K |
| D0603 |
|
13,845 |
11,061 |
$147K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,446 |
690 |
$140K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,718 |
4,631 |
$133K |
| D1354 |
|
6,335 |
1,949 |
$128K |
| D2740 |
Crown - porcelain/ceramic |
499 |
274 |
$118K |
| D9999 |
Unspecified adjunctive procedure, by report |
4,186 |
4,059 |
$117K |
| D2335 |
|
606 |
330 |
$111K |
| D9310 |
|
2,970 |
2,801 |
$97K |
| D2950 |
|
611 |
367 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,336 |
1,310 |
$40K |
| D4346 |
|
948 |
878 |
$36K |
| D8670 |
Periodic orthodontic treatment visit |
351 |
302 |
$24K |
| D5110 |
|
42 |
41 |
$21K |
| D0350 |
|
1,323 |
1,291 |
$18K |
| D3120 |
|
5,502 |
3,147 |
$18K |
| D3240 |
|
45 |
37 |
$17K |
| D7111 |
|
445 |
316 |
$14K |
| D0999 |
Unspecified diagnostic procedure, by report |
597 |
597 |
$12K |
| D2332 |
|
273 |
168 |
$12K |
| D1517 |
|
85 |
80 |
$10K |
| D9239 |
|
705 |
647 |
$7K |
| D1516 |
|
27 |
25 |
$7K |
| D3310 |
|
20 |
12 |
$7K |
| D1999 |
|
168 |
167 |
$6K |
| D0602 |
|
5,105 |
4,508 |
$6K |
| D0240 |
|
1,456 |
1,362 |
$6K |
| D2330 |
|
347 |
195 |
$5K |
| D7230 |
|
46 |
25 |
$4K |
| D5120 |
|
12 |
12 |
$2K |
| D2331 |
|
35 |
27 |
$2K |
| D4341 |
|
187 |
63 |
$1K |
| D8660 |
|
911 |
881 |
$290.69 |
| D0270 |
|
105 |
95 |
$38.39 |
| D0470 |
|
885 |
861 |
$0.00 |
| D8020 |
|
92 |
90 |
$0.00 |
| D0340 |
|
885 |
860 |
$0.00 |
| D8680 |
|
1,246 |
1,219 |
$0.00 |
| D7922 |
|
1,195 |
438 |
$0.00 |
| D9986 |
|
1,706 |
1,643 |
$0.00 |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
646 |
628 |
$0.00 |
| D0460 |
|
34 |
34 |
$0.00 |
| D4265 |
|
24 |
12 |
$0.00 |