| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
142,428 |
33,294 |
$3.06M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
32,603 |
13,661 |
$2.95M |
| D1120 |
Prophylaxis - child |
107,196 |
106,158 |
$2.94M |
| D0120 |
Periodic oral evaluation - established patient |
87,051 |
86,358 |
$2.04M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34,981 |
22,076 |
$1.66M |
| D1206 |
Topical application of fluoride varnish |
107,398 |
106,353 |
$1.52M |
| D7140 |
Extraction, erupted tooth or exposed root |
15,199 |
9,202 |
$947K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20,366 |
20,023 |
$797K |
| D9420 |
|
3,148 |
3,000 |
$674K |
| D0272 |
Bitewings - two radiographic images |
56,305 |
55,823 |
$577K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,372 |
8,954 |
$503K |
| D2929 |
|
3,834 |
1,207 |
$438K |
| D0603 |
|
89,099 |
88,201 |
$430K |
| D0140 |
Limited oral evaluation - problem focused |
13,776 |
13,514 |
$429K |
| D0220 |
Intraoral - periapical first radiographic image |
75,818 |
75,154 |
$413K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,886 |
3,237 |
$367K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,816 |
5,421 |
$309K |
| D0210 |
Intraoral - complete series of radiographic images |
6,206 |
6,041 |
$291K |
| D1110 |
Prophylaxis - adult |
5,916 |
5,873 |
$228K |
| D9920 |
|
10,466 |
9,748 |
$214K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,010 |
16,177 |
$203K |
| D0230 |
Intraoral - periapical each additional radiographic image |
62,261 |
61,118 |
$162K |
| D8670 |
Periodic orthodontic treatment visit |
3,277 |
3,060 |
$129K |
| D2332 |
|
1,900 |
1,327 |
$106K |
| D0240 |
|
23,213 |
17,692 |
$106K |
| D0274 |
Bitewings - four radiographic images |
19,250 |
19,046 |
$98K |
| D0145 |
Oral evaluation for a patient under three years of age |
6,284 |
6,197 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,924 |
4,837 |
$67K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
107 |
107 |
$66K |
| D0330 |
Panoramic radiographic image |
3,111 |
3,052 |
$63K |
| D0602 |
|
5,955 |
5,918 |
$42K |
| D2335 |
|
306 |
206 |
$33K |
| D8660 |
|
817 |
811 |
$29K |
| D9248 |
|
141 |
122 |
$12K |
| D0601 |
|
1,680 |
1,642 |
$11K |
| D2330 |
|
211 |
140 |
$11K |
| D2394 |
|
150 |
136 |
$5K |
| D1510 |
|
29 |
26 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,317 |
1,282 |
$979.08 |
| D1354 |
|
228 |
66 |
$365.00 |
| D0171 |
|
17 |
17 |
$190.00 |
| D9995 |
|
49 |
46 |
$15.00 |
| D1999 |
|
12,572 |
12,313 |
$0.00 |
| D1330 |
|
194 |
192 |
$0.00 |