| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
465 |
444 |
$1.26M |
| D1120 |
Prophylaxis - child |
20,649 |
19,856 |
$891K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,654 |
2,382 |
$760K |
| D1206 |
Topical application of fluoride varnish |
21,119 |
20,251 |
$739K |
| D0274 |
Bitewings - four radiographic images |
17,657 |
16,764 |
$352K |
| D1351 |
Sealant - per tooth |
18,600 |
3,432 |
$349K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,292 |
3,383 |
$307K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,233 |
9,763 |
$300K |
| D0120 |
Periodic oral evaluation - established patient |
9,911 |
9,505 |
$226K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,720 |
23,677 |
$200K |
| D0220 |
Intraoral - periapical first radiographic image |
18,430 |
17,324 |
$166K |
| D0140 |
Limited oral evaluation - problem focused |
5,327 |
4,961 |
$152K |
| D9420 |
|
3,959 |
3,717 |
$150K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,462 |
1,231 |
$137K |
| D0350 |
|
17,846 |
9,527 |
$133K |
| D0330 |
Panoramic radiographic image |
3,909 |
3,584 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,406 |
1,476 |
$92K |
| D2929 |
|
607 |
235 |
$72K |
| D8660 |
|
1,586 |
1,487 |
$71K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,545 |
663 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,499 |
3,284 |
$60K |
| D7111 |
|
1,690 |
590 |
$48K |
| D0272 |
Bitewings - two radiographic images |
1,956 |
1,865 |
$31K |
| D1110 |
Prophylaxis - adult |
721 |
656 |
$28K |
| D9999 |
Unspecified adjunctive procedure, by report |
785 |
785 |
$24K |
| D0999 |
Unspecified diagnostic procedure, by report |
622 |
621 |
$20K |
| D0240 |
|
1,063 |
981 |
$12K |
| D0603 |
|
3,989 |
3,588 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
416 |
388 |
$7K |
| D2330 |
|
110 |
68 |
$6K |
| D0602 |
|
1,997 |
1,930 |
$5K |
| D2933 |
|
53 |
13 |
$5K |
| D1510 |
|
41 |
27 |
$4K |
| D1353 |
|
329 |
93 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
27 |
$2K |
| D1999 |
|
113 |
113 |
$2K |
| D4346 |
|
61 |
48 |
$2K |
| D3120 |
|
92 |
44 |
$1K |
| D0601 |
|
570 |
564 |
$1K |
| D2332 |
|
17 |
12 |
$1K |
| D2940 |
|
48 |
25 |
$1K |