| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
179,654 |
175,269 |
$9.64M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63,419 |
35,471 |
$4.18M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
135,974 |
132,904 |
$3.88M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
33,469 |
14,352 |
$3.77M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,807 |
1,762 |
$3.42M |
| D1206 |
Topical application of fluoride varnish |
121,140 |
118,439 |
$1.93M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36,146 |
22,874 |
$1.90M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
52,686 |
49,633 |
$1.84M |
| D7140 |
Extraction, erupted tooth or exposed root |
33,201 |
17,794 |
$1.75M |
| D0120 |
Periodic oral evaluation - established patient |
74,977 |
72,819 |
$1.75M |
| D0272 |
Bitewings - two radiographic images |
91,218 |
88,756 |
$1.63M |
| D0330 |
Panoramic radiographic image |
32,793 |
31,981 |
$1.47M |
| D1110 |
Prophylaxis - adult |
27,456 |
26,675 |
$1.45M |
| D8670 |
Periodic orthodontic treatment visit |
1,440 |
1,413 |
$1.34M |
| D1208 |
Topical application of fluoride, excluding varnish |
80,333 |
77,992 |
$1.21M |
| D1351 |
Sealant - per tooth |
56,476 |
18,305 |
$1.17M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
11,866 |
5,981 |
$755K |
| D0220 |
Intraoral - periapical first radiographic image |
54,317 |
51,935 |
$553K |
| D0230 |
Intraoral - periapical each additional radiographic image |
58,464 |
28,841 |
$450K |
| D0274 |
Bitewings - four radiographic images |
11,905 |
11,580 |
$358K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,319 |
3,240 |
$344K |
| D2332 |
|
4,190 |
2,468 |
$329K |
| D0140 |
Limited oral evaluation - problem focused |
9,742 |
9,346 |
$328K |
| D2330 |
|
5,002 |
3,150 |
$260K |
| D9248 |
|
4,139 |
3,950 |
$239K |
| D9420 |
|
3,712 |
3,483 |
$190K |
| D2335 |
|
1,444 |
712 |
$132K |
| D8999 |
|
327 |
318 |
$110K |
| D2331 |
|
1,213 |
845 |
$80K |
| D8660 |
|
909 |
879 |
$74K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,618 |
1,590 |
$43K |
| D2932 |
|
381 |
148 |
$41K |
| D7111 |
|
723 |
397 |
$33K |
| D1330 |
|
4,256 |
4,034 |
$21K |
| D9110 |
|
771 |
741 |
$20K |
| D8680 |
|
218 |
216 |
$18K |
| D1354 |
|
1,730 |
715 |
$15K |
| D7962 |
|
75 |
71 |
$10K |
| D7961 |
|
68 |
63 |
$9K |
| D8704 |
|
58 |
54 |
$5K |
| D8703 |
|
44 |
41 |
$4K |
| D9986 |
|
3,673 |
3,475 |
$1K |
| D3110 |
|
80 |
39 |
$1K |
| D0270 |
|
18 |
18 |
$116.42 |
| D0190 |
|
23 |
22 |
$27.00 |
| D0603 |
|
507 |
504 |
$0.00 |
| D9215 |
|
202 |
174 |
$0.00 |
| D9995 |
|
28 |
28 |
$0.00 |
| D1999 |
|
1,871 |
1,724 |
$0.00 |
| 888888 |
|
180 |
137 |
$0.00 |