| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
22,047 |
21,730 |
$953K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,132 |
5,207 |
$859K |
| D0120 |
Periodic oral evaluation - established patient |
24,822 |
24,452 |
$729K |
| D1206 |
Topical application of fluoride varnish |
27,419 |
27,017 |
$676K |
| D1351 |
Sealant - per tooth |
18,538 |
5,259 |
$623K |
| D8670 |
Periodic orthodontic treatment visit |
6,332 |
6,167 |
$469K |
| D1110 |
Prophylaxis - adult |
5,124 |
5,049 |
$306K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,881 |
617 |
$292K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,563 |
1,573 |
$270K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,620 |
10,869 |
$211K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,699 |
1,337 |
$162K |
| D0330 |
Panoramic radiographic image |
3,671 |
3,619 |
$157K |
| D0272 |
Bitewings - two radiographic images |
9,289 |
9,161 |
$141K |
| D0274 |
Bitewings - four radiographic images |
4,561 |
4,491 |
$101K |
| D1330 |
|
16,122 |
15,882 |
$98K |
| D3120 |
|
2,846 |
1,606 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,840 |
1,819 |
$96K |
| D0220 |
Intraoral - periapical first radiographic image |
4,798 |
4,733 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
844 |
824 |
$37K |
| D0240 |
|
1,962 |
1,928 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,521 |
2,509 |
$29K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
26 |
26 |
$27K |
| D9310 |
|
259 |
255 |
$12K |
| D8660 |
|
49 |
49 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |