| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
55,865 |
55,625 |
$1.77M |
| D1208 |
Topical application of fluoride, excluding varnish |
54,927 |
54,683 |
$996K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26,877 |
26,787 |
$938K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,973 |
2,716 |
$824K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,964 |
6,038 |
$730K |
| D0120 |
Periodic oral evaluation - established patient |
28,752 |
28,661 |
$656K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
154 |
146 |
$544K |
| D0272 |
Bitewings - two radiographic images |
22,647 |
22,540 |
$460K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,886 |
14,340 |
$406K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,542 |
4,377 |
$358K |
| D0220 |
Intraoral - periapical first radiographic image |
27,331 |
27,134 |
$312K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,588 |
22,604 |
$286K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,895 |
1,035 |
$231K |
| D0274 |
Bitewings - four radiographic images |
7,761 |
7,742 |
$231K |
| D0140 |
Limited oral evaluation - problem focused |
6,876 |
6,780 |
$202K |
| D1351 |
Sealant - per tooth |
8,154 |
2,606 |
$193K |
| D8660 |
|
1,826 |
1,820 |
$187K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,694 |
1,661 |
$178K |
| D0330 |
Panoramic radiographic image |
1,969 |
1,964 |
$99K |
| D0240 |
|
6,583 |
4,038 |
$83K |
| D9420 |
|
775 |
768 |
$57K |
| D2934 |
|
336 |
88 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
209 |
164 |
$19K |
| D9248 |
|
530 |
513 |
$12K |
| D1206 |
Topical application of fluoride varnish |
379 |
379 |
$7K |
| D1110 |
Prophylaxis - adult |
87 |
87 |
$4K |
| D2332 |
|
18 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$841.96 |
| D1999 |
|
168 |
143 |
$0.00 |