| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
43,078 |
42,766 |
$1.84M |
| D0120 |
Periodic oral evaluation - established patient |
29,023 |
28,820 |
$1.67M |
| D8670 |
Periodic orthodontic treatment visit |
2,671 |
2,612 |
$735K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,045 |
6,116 |
$704K |
| D1351 |
Sealant - per tooth |
21,399 |
5,835 |
$663K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,233 |
11,145 |
$655K |
| D1310 |
|
12,136 |
12,057 |
$567K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,252 |
2,615 |
$516K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,639 |
10,915 |
$472K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,712 |
27,519 |
$424K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,546 |
3,939 |
$384K |
| D0230 |
Intraoral - periapical each additional radiographic image |
72,452 |
20,776 |
$313K |
| D7240 |
Removal of impacted tooth - completely bony |
1,227 |
470 |
$278K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,708 |
3,077 |
$266K |
| D9993 |
|
3,800 |
3,794 |
$243K |
| D1206 |
Topical application of fluoride varnish |
13,012 |
12,917 |
$237K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,078 |
1,424 |
$204K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,151 |
3,132 |
$190K |
| D0274 |
Bitewings - four radiographic images |
8,813 |
8,756 |
$190K |
| D0272 |
Bitewings - two radiographic images |
13,892 |
13,804 |
$168K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,274 |
590 |
$163K |
| D0220 |
Intraoral - periapical first radiographic image |
11,307 |
11,183 |
$140K |
| D0603 |
|
6,906 |
6,862 |
$104K |
| D9430 |
|
2,949 |
2,918 |
$95K |
| D0330 |
Panoramic radiographic image |
2,822 |
2,787 |
$86K |
| D0601 |
|
4,264 |
4,233 |
$69K |
| D1354 |
|
3,713 |
987 |
$46K |
| D9310 |
|
539 |
536 |
$27K |
| D7230 |
|
114 |
65 |
$22K |
| D0340 |
|
545 |
532 |
$22K |
| D0350 |
|
2,235 |
1,235 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
161 |
134 |
$16K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
12 |
12 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
344 |
332 |
$10K |
| D2330 |
|
103 |
63 |
$8K |
| D7220 |
|
42 |
25 |
$6K |
| D0470 |
|
546 |
532 |
$5K |
| D0602 |
|
337 |
337 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
103 |
102 |
$4K |
| D8660 |
|
15 |
15 |
$535.00 |
| D4921 |
|
44 |
20 |
$0.00 |