| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,121 |
12,068 |
$529K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,485 |
2,917 |
$466K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,593 |
2,766 |
$397K |
| D0120 |
Periodic oral evaluation - established patient |
11,073 |
11,034 |
$363K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,967 |
10,920 |
$302K |
| D8670 |
Periodic orthodontic treatment visit |
5,754 |
5,693 |
$253K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,991 |
2,462 |
$172K |
| D0240 |
|
7,657 |
4,349 |
$158K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,600 |
2,545 |
$123K |
| D0274 |
Bitewings - four radiographic images |
1,982 |
1,973 |
$90K |
| D1351 |
Sealant - per tooth |
1,913 |
884 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
637 |
424 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
2,824 |
2,804 |
$51K |
| D0272 |
Bitewings - two radiographic images |
1,406 |
1,405 |
$43K |
| D1206 |
Topical application of fluoride varnish |
697 |
696 |
$19K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
17 |
15 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
42 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
108 |
108 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
28 |
26 |
$6K |
| D7111 |
|
58 |
37 |
$5K |
| D0330 |
Panoramic radiographic image |
53 |
53 |
$4K |
| D8660 |
|
129 |
129 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
80 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
28 |
26 |
$4K |