| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,553 |
17,983 |
$749K |
| D0120 |
Periodic oral evaluation - established patient |
19,229 |
18,617 |
$528K |
| D4341 |
|
3,238 |
1,531 |
$482K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,615 |
17,068 |
$452K |
| D1351 |
Sealant - per tooth |
7,885 |
3,055 |
$427K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,788 |
4,776 |
$415K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,433 |
3,774 |
$219K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,253 |
8,895 |
$207K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,307 |
1,487 |
$173K |
| D1110 |
Prophylaxis - adult |
4,333 |
4,195 |
$171K |
| D0274 |
Bitewings - four radiographic images |
8,577 |
8,255 |
$147K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,772 |
1,392 |
$134K |
| D0210 |
Intraoral - complete series of radiographic images |
4,367 |
4,173 |
$127K |
| D0220 |
Intraoral - periapical first radiographic image |
20,465 |
19,374 |
$122K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,266 |
1,573 |
$121K |
| D8670 |
Periodic orthodontic treatment visit |
418 |
416 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,276 |
16,266 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
5,207 |
4,957 |
$91K |
| D0272 |
Bitewings - two radiographic images |
4,413 |
4,249 |
$43K |
| D2332 |
|
304 |
219 |
$29K |
| D2740 |
Crown - porcelain/ceramic |
88 |
72 |
$25K |
| D9110 |
|
457 |
443 |
$24K |
| D2335 |
|
258 |
202 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
549 |
489 |
$21K |
| D2330 |
|
328 |
190 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
142 |
74 |
$15K |
| D2331 |
|
197 |
151 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
177 |
105 |
$14K |
| D2950 |
|
196 |
171 |
$12K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
12 |
12 |
$11K |
| D8999 |
|
221 |
219 |
$10K |
| D1206 |
Topical application of fluoride varnish |
208 |
202 |
$5K |
| D8660 |
|
13 |
13 |
$1K |
| D0270 |
|
194 |
186 |
$1K |
| D9310 |
|
64 |
63 |
$1K |
| D2940 |
|
69 |
59 |
$949.20 |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$865.60 |
| D4910 |
|
12 |
12 |
$737.00 |
| D0601 |
|
114 |
112 |
$0.00 |