| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
20,969 |
20,324 |
$546K |
| D1110 |
Prophylaxis - adult |
11,578 |
11,304 |
$546K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
904 |
837 |
$514K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,617 |
22,090 |
$444K |
| D0220 |
Intraoral - periapical first radiographic image |
23,070 |
22,303 |
$395K |
| D0272 |
Bitewings - two radiographic images |
16,294 |
15,814 |
$394K |
| D1120 |
Prophylaxis - child |
10,976 |
10,715 |
$389K |
| D8670 |
Periodic orthodontic treatment visit |
3,060 |
1,871 |
$333K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,548 |
20,923 |
$309K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,245 |
1,621 |
$251K |
| D0210 |
Intraoral - complete series of radiographic images |
1,312 |
1,212 |
$99K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
679 |
157 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,779 |
2,689 |
$91K |
| D0274 |
Bitewings - four radiographic images |
3,384 |
3,309 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,384 |
834 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
2,660 |
2,514 |
$78K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,052 |
2,827 |
$76K |
| D2160 |
|
527 |
303 |
$48K |
| D2140 |
|
724 |
354 |
$46K |
| D9248 |
|
453 |
421 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
351 |
111 |
$29K |
| D0601 |
|
6,056 |
5,906 |
$29K |
| D0603 |
|
4,928 |
4,819 |
$24K |
| D0602 |
|
4,870 |
4,769 |
$24K |
| D7111 |
|
120 |
79 |
$6K |
| D1351 |
Sealant - per tooth |
115 |
27 |
$3K |
| D2931 |
|
15 |
13 |
$2K |