| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
35,247 |
34,545 |
$1.81M |
| D8670 |
Periodic orthodontic treatment visit |
5,825 |
5,341 |
$1.29M |
| D1208 |
Topical application of fluoride, excluding varnish |
41,252 |
40,484 |
$1.21M |
| D0120 |
Periodic oral evaluation - established patient |
36,356 |
35,713 |
$1.07M |
| D1351 |
Sealant - per tooth |
18,010 |
5,679 |
$725K |
| D0274 |
Bitewings - four radiographic images |
16,565 |
16,272 |
$718K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,801 |
1,864 |
$702K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,820 |
3,431 |
$551K |
| D0272 |
Bitewings - two radiographic images |
15,463 |
15,123 |
$468K |
| D1110 |
Prophylaxis - adult |
5,549 |
5,450 |
$382K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,347 |
5,241 |
$307K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,888 |
1,827 |
$255K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,126 |
1,738 |
$193K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,313 |
8,742 |
$189K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
170 |
157 |
$176K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,609 |
1,042 |
$154K |
| D0330 |
Panoramic radiographic image |
2,597 |
2,527 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
6,570 |
6,322 |
$129K |
| D8680 |
|
1,123 |
1,044 |
$95K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
937 |
522 |
$90K |
| D8660 |
|
2,576 |
2,531 |
$84K |
| D2140 |
|
1,063 |
814 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
1,467 |
1,424 |
$67K |
| D9310 |
|
1,197 |
1,035 |
$58K |
| D8690 |
|
363 |
351 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,401 |
1,932 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
267 |
240 |
$33K |
| D7111 |
|
141 |
111 |
$11K |
| D1510 |
|
30 |
26 |
$7K |
| D1206 |
Topical application of fluoride varnish |
177 |
177 |
$5K |
| D3120 |
|
46 |
40 |
$2K |