| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,143 |
19,576 |
$1.00M |
| D8670 |
Periodic orthodontic treatment visit |
3,303 |
3,101 |
$799K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,201 |
979 |
$604K |
| D1206 |
Topical application of fluoride varnish |
23,524 |
22,758 |
$595K |
| D0120 |
Periodic oral evaluation - established patient |
17,845 |
17,244 |
$503K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,710 |
1,890 |
$345K |
| D0272 |
Bitewings - two radiographic images |
7,767 |
7,458 |
$227K |
| D1110 |
Prophylaxis - adult |
3,155 |
2,962 |
$191K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,690 |
1,265 |
$183K |
| D1351 |
Sealant - per tooth |
4,423 |
1,722 |
$158K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,876 |
1,579 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,751 |
2,697 |
$155K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
133 |
123 |
$154K |
| D0140 |
Limited oral evaluation - problem focused |
3,364 |
3,161 |
$146K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,248 |
6,484 |
$141K |
| D0274 |
Bitewings - four radiographic images |
3,048 |
2,958 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
6,287 |
5,945 |
$117K |
| D0330 |
Panoramic radiographic image |
958 |
933 |
$76K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
763 |
474 |
$66K |
| D9310 |
|
1,124 |
977 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,654 |
2,086 |
$50K |
| D8660 |
|
415 |
386 |
$39K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
360 |
214 |
$36K |
| D8690 |
|
141 |
131 |
$17K |
| D8999 |
|
190 |
177 |
$9K |
| D8680 |
|
71 |
19 |
$6K |
| D2140 |
|
15 |
12 |
$924.00 |