| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
25,580 |
24,526 |
$1.10M |
| D1120 |
Prophylaxis - child |
23,847 |
22,896 |
$1.03M |
| D1351 |
Sealant - per tooth |
18,061 |
2,740 |
$776K |
| D8670 |
Periodic orthodontic treatment visit |
12,436 |
10,685 |
$561K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,344 |
3,305 |
$552K |
| D1206 |
Topical application of fluoride varnish |
14,301 |
13,665 |
$436K |
| D8680 |
|
329 |
296 |
$369K |
| D0272 |
Bitewings - two radiographic images |
11,887 |
11,467 |
$353K |
| D0220 |
Intraoral - periapical first radiographic image |
16,113 |
15,368 |
$230K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,637 |
9,329 |
$210K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,015 |
13,703 |
$172K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
240 |
224 |
$154K |
| D0274 |
Bitewings - four radiographic images |
5,482 |
5,189 |
$151K |
| D1110 |
Prophylaxis - adult |
2,852 |
2,742 |
$150K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
952 |
741 |
$111K |
| D0330 |
Panoramic radiographic image |
1,490 |
1,427 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,085 |
812 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,020 |
5,253 |
$92K |
| D0603 |
|
7,390 |
7,098 |
$67K |
| D0602 |
|
5,473 |
5,230 |
$51K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
218 |
137 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
830 |
820 |
$37K |
| D8660 |
|
845 |
777 |
$34K |
| D9310 |
|
1,613 |
1,520 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
183 |
95 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
394 |
373 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
136 |
97 |
$16K |
| D0601 |
|
319 |
319 |
$3K |
| D2330 |
|
20 |
14 |
$2K |
| D1353 |
|
78 |
25 |
$780.00 |