| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
30,995 |
7,310 |
$578K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,742 |
22,577 |
$540K |
| D1120 |
Prophylaxis - child |
19,382 |
19,243 |
$496K |
| D8670 |
Periodic orthodontic treatment visit |
8,173 |
7,681 |
$459K |
| D0120 |
Periodic oral evaluation - established patient |
17,931 |
17,799 |
$352K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,177 |
1,099 |
$200K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,467 |
2,089 |
$188K |
| D0251 |
|
17,947 |
17,805 |
$147K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,224 |
1,432 |
$133K |
| D9920 |
|
7,782 |
5,925 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,908 |
4,874 |
$123K |
| D1110 |
Prophylaxis - adult |
3,012 |
2,982 |
$109K |
| D1353 |
|
9,438 |
2,015 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,904 |
1,199 |
$96K |
| D0603 |
|
11,103 |
11,031 |
$94K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,760 |
829 |
$86K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,492 |
2,291 |
$42K |
| D0250 |
|
3,860 |
3,835 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
914 |
595 |
$35K |
| D1354 |
|
2,039 |
636 |
$35K |
| D9420 |
|
103 |
101 |
$32K |
| D9310 |
|
1,315 |
1,299 |
$24K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
26 |
26 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
697 |
685 |
$15K |
| D2140 |
|
458 |
335 |
$15K |
| D8680 |
|
13 |
13 |
$14K |
| D0330 |
Panoramic radiographic image |
644 |
630 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
2,217 |
2,195 |
$9K |
| D0602 |
|
1,013 |
995 |
$8K |
| D0340 |
|
573 |
559 |
$8K |
| D0272 |
Bitewings - two radiographic images |
1,571 |
1,569 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,034 |
2,028 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
138 |
$4K |
| D0601 |
|
344 |
344 |
$3K |
| D0274 |
Bitewings - four radiographic images |
322 |
322 |
$3K |
| D9110 |
|
155 |
147 |
$2K |
| D0350 |
|
1,957 |
616 |
$2K |
| D2330 |
|
19 |
14 |
$975.00 |
| D1999 |
|
40 |
40 |
$0.00 |