| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
168,635 |
34,549 |
$2.26M |
| D1120 |
Prophylaxis - child |
83,933 |
83,576 |
$1.60M |
| D0120 |
Periodic oral evaluation - established patient |
88,868 |
88,480 |
$1.33M |
| D8670 |
Periodic orthodontic treatment visit |
34,956 |
32,367 |
$1.19M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29,997 |
21,398 |
$975K |
| D1208 |
Topical application of fluoride, excluding varnish |
86,616 |
86,329 |
$612K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18,684 |
13,925 |
$512K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
786 |
772 |
$410K |
| D0330 |
Panoramic radiographic image |
17,441 |
17,337 |
$332K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,689 |
7,940 |
$318K |
| D0273 |
|
37,035 |
36,905 |
$258K |
| D8660 |
|
8,347 |
8,239 |
$239K |
| D8680 |
|
276 |
240 |
$171K |
| D1110 |
Prophylaxis - adult |
10,213 |
10,173 |
$156K |
| D0603 |
|
26,730 |
26,532 |
$154K |
| D1206 |
Topical application of fluoride varnish |
7,894 |
7,721 |
$113K |
| D0140 |
Limited oral evaluation - problem focused |
7,452 |
7,360 |
$100K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,335 |
2,105 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,291 |
5,248 |
$82K |
| D7111 |
|
3,090 |
2,079 |
$80K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
980 |
734 |
$80K |
| D0602 |
|
13,905 |
13,831 |
$77K |
| D2750 |
|
206 |
158 |
$68K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
267 |
224 |
$61K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,261 |
3,227 |
$43K |
| D0272 |
Bitewings - two radiographic images |
7,242 |
7,192 |
$36K |
| D2331 |
|
1,004 |
745 |
$33K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
976 |
721 |
$32K |
| D2330 |
|
1,102 |
758 |
$31K |
| D9310 |
|
2,292 |
2,254 |
$22K |
| D2950 |
|
500 |
380 |
$18K |
| D2332 |
|
385 |
253 |
$16K |
| D0601 |
|
2,321 |
2,305 |
$13K |
| D2335 |
|
181 |
115 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
187 |
187 |
$528.15 |
| D9986 |
|
7,744 |
7,415 |
$0.00 |
| D9430 |
|
27 |
25 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
92 |
92 |
$0.00 |