| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
182,500 |
182,478 |
$6.80M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
30,877 |
12,784 |
$4.80M |
| D0120 |
Periodic oral evaluation - established patient |
190,140 |
190,113 |
$4.68M |
| D1110 |
Prophylaxis - adult |
65,429 |
65,421 |
$3.40M |
| D1206 |
Topical application of fluoride varnish |
103,063 |
103,003 |
$2.58M |
| D1351 |
Sealant - per tooth |
48,799 |
19,650 |
$2.37M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21,582 |
18,145 |
$1.69M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30,786 |
26,344 |
$1.62M |
| D1208 |
Topical application of fluoride, excluding varnish |
128,515 |
128,502 |
$1.61M |
| D7140 |
Extraction, erupted tooth or exposed root |
28,343 |
17,915 |
$1.54M |
| D0330 |
Panoramic radiographic image |
37,516 |
37,508 |
$1.23M |
| D7240 |
Removal of impacted tooth - completely bony |
2,825 |
1,195 |
$970K |
| D0272 |
Bitewings - two radiographic images |
66,437 |
66,419 |
$911K |
| D0274 |
Bitewings - four radiographic images |
26,686 |
26,677 |
$642K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,878 |
3,473 |
$556K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17,082 |
17,081 |
$458K |
| D8670 |
Periodic orthodontic treatment visit |
1,806 |
1,804 |
$372K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32,366 |
31,732 |
$333K |
| D0145 |
Oral evaluation for a patient under three years of age |
10,604 |
10,601 |
$272K |
| D9310 |
|
3,501 |
3,498 |
$261K |
| D2390 |
|
2,354 |
1,202 |
$226K |
| D0140 |
Limited oral evaluation - problem focused |
17,010 |
16,951 |
$202K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,378 |
875 |
$134K |
| D9222 |
|
1,845 |
1,845 |
$133K |
| D7230 |
|
682 |
436 |
$131K |
| D2330 |
|
2,233 |
1,487 |
$127K |
| D0220 |
Intraoral - periapical first radiographic image |
9,690 |
9,668 |
$112K |
| D0210 |
Intraoral - complete series of radiographic images |
4,429 |
4,427 |
$105K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,433 |
1,431 |
$102K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
416 |
377 |
$42K |
| D9999 |
Unspecified adjunctive procedure, by report |
393 |
393 |
$29K |
| D0340 |
|
644 |
641 |
$25K |
| D8660 |
|
744 |
740 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,379 |
2,369 |
$16K |
| D2331 |
|
193 |
140 |
$16K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
12 |
12 |
$12K |
| D0350 |
|
689 |
686 |
$7K |
| D9995 |
|
216 |
214 |
$4K |
| D1999 |
|
7,973 |
7,796 |
$4K |
| D2335 |
|
17 |
15 |
$2K |
| D2332 |
|
18 |
12 |
$2K |
| D9239 |
|
27 |
27 |
$800.00 |
| D9243 |
|
27 |
27 |
$655.00 |
| D0240 |
|
38 |
38 |
$588.71 |
| D9996 |
|
28 |
26 |
$263.76 |
| D1330 |
|
58 |
58 |
$0.00 |
| D9248 |
|
73 |
73 |
$0.00 |
| D3120 |
|
13 |
13 |
$0.00 |
| D9986 |
|
17 |
17 |
$0.00 |